Doing first Curve today - 2H after insulin 2.5mmol/L should I panic?

Hi Everyone! I am doing my first blood curve for Ion today. The vet said to take a reading right before food/insulin and then every 3 hours until meal time tonight. I am a bit worried, I took a reading before he ate (9:16AM) and he was at 4.6mmol/L, I let him eat and then took another reading at 10:12AM and he was only 5.5mmol/L. I called the vet and she wasn't in the office yet but the lady said to just give him the normal dosage and continue with the curve. So i have him 0.5 units of Lantus and then at 12:26 took the next reading and he is now at 2.6 mmol/L. He is acting fine and is walking around and is able to jump onto the couch and stuff, but should I be panicking and giving him some syrup or anything I don't want to ruin my first curve but I don't want to be hurting him I have my spreadsheet all filled out incase that helps! Also he does not like to eat his food in one sitting, i have been trying and trying, and while I do feel like he is eating more than he was before we started the insulin, he wont eat it all in 2 meals the way the vet says he has to. I have to just leave his food out for him throughout the day and usually he eats most of it. I am feeding him Friskies Pate food, and give him around 2/3-3/4 a can in one meal.

Also i have to poke his ear a few times to get blood (he wont let me get anywhere near him with the lancet so i am just using a needle) i feel so horrible i wish i could help him better

 

Don’t panic, but do give some food, higher carb if you have it and test again.

 

You can feed him throughout the cycle, just not 2.hours before Preshot test. Don’t worry about ruining his first curve

@JL and Chip can you keep watch here? I need to run out for about an hour

 

@Cat_Ion have you gotten another test?

 

I'm here and I'll be happy to keep an eye out. Sharon gave you good advice. Yes, his level has dipped a bit low, but his behavior is normal and you're feeding him. This is a great time for a little high-carb food, but don't overdo it unless his BGL drops further. And you don't have to wait three hours to test again. You can test as close as every 20 minutes, just until you see his BGL is coming up again. I know when Billy dipped that low, I tested about every 30 minutes for a few tests just to make sure he was coming back up. It really helped me stay calm to see that proof he wasn't dropping further.

 

Thank you guys I’m going to do another test right now I did get him to eat some more of his food ! I’ll test again now and if it’s still low I still have some of his old kibble which is definitely higher in carbs! Will let you know what the new tests says ASAP.

 

Keep it up, take a deep breath, you are doing great!

 

sorry that took so long i have such a hard time getting him to bleed and keep having to sooth him. but this time his blood was at 2.8mmol/L. He is still acting totally fine :S he jumped onto his kitty tree and he ate some food. shouldnt he be in some type of shock this low?

 

Sorry, lost my internet for a hot minute. He's coming up, even if it's slowly. On my human meter he'd be at 50 now. Under 50 is keep an eye on them because it's a concern, under 30 is a medical emergency. He's eating, he's acting normal. I would test again in a bit to make sure he keeps coming up, but he's doing great so far.

If this happens again, you might try a slightly smaller dose, but more experienced members can help with that after you have more readings.

Great job taking care of your boy!

 

Hi instead of giving him kibble for a higher carb, here is the carbs for wet food

Low carb is generally considered under 10%.

Between 11% and 17% is medium carbs.

18% and over is high carb. These are typically gravy-based foods
I see you are feeding him Friskies Pate Food
If you look under the Feline Health (Welcome & Main Forum) you will see
Dr Pierson new/Foods Chart which lists all the carb percentages of all the different types of the Friskies Foods
Its better to give the wet foods rather than kibble to bring their BG up
Take a look at the Friskies Savory Shreds or the Friskies Prime Fillets or the Friskies Gravy Sensations for medium carb maybe the Beef In Gravy and the Chicken In Gravy
If you ever need a high carb I see the Friskies Gravy Sensations Beef & Chicken in Gravy is 20% carbs
You would just want to give him maybe a tablespoon or less at a time so he doesn't get full in case you still need to bring his BG up


Just an FYI, it takes a lot longer for dry food to get into the system (and exit the system),
If he doesn't like the texture of them you can pour the gravy into a dish and just let him lick that up
My cat really only like pates so when I have to use a higher carb I just get my fingers and squeeze the food together until it almost becomes like a pate.
I hope this helps also we usually feed a few times a day not just twice a day
Just no food 2 hrs prior to his Am pre shot and PM pre shot @Cat_Ion

 

Just did another reading and he is at 3.6 now

 

Huzzah! It's coming up!

 

Thank you so much! do you mean that you don't let him eat anything right before the shot either? the vet told me I need to get him to eat right before the shot and give the shot to him within 30 minutes to an hour max after eating? honestly the food stuff is surprisingly the hardest part of this journey so far its very confusing and frustrating, I wish he would eat like a dog hahhaa

 

Don't let him eat 2 hours before the shot-- test blood sugar, then feed, then inject. Not letting him eat for two hours preshot gets you a more honest blood glucose level when you test, so the level isn't temporarily pumped up from eating. It also helps make sure he is hungry so he'll eat before the insulin is given.

 

Another question for all of you, I'm worried something else is wrong, the reason i brought Ion to the vet in the first place was because he wasn't really eating food and was drinking a lot. When he did eat he chewed funny and made a loud noise, so I thought his teeth were hurting. The vet looked at his teeth and said they looked fine and did blood work because of the drinking. That's how we found out about the diabetes. Now that I have switched him to wet food i noticed he still makes the weird chewing sound... like hes crunching something... but he's eating pate there is nothing hard in his food! Has anyone experienced this before? I took a video I will try and attach here.

 

okay that didn't work hahah I uploaded the video to imgur Here

I am worried this is a sign of something else going on, i read online that cat grinding can be a sign of liver disease and pancreatitis etc. also maybe its why he is so fussy about his food?

 

Take care look at #10 in case you missed my post about foods

 

With Lantus insulin the order is test, feed, shoot. All within about 15 minutes.

 

Cat_Ion

My Simba The Ever Wise One, decided on his own how to eat his wet food knowing how his own body work.

He ate the m/d wet, because no other suitable food was available to him. And I had it calculated in how many grams of food he needed to eat in a whole day, which became 156 grams a day, which was 1 can of the m/d wet food.

His insulin schedule was 10 a.m and 10 p.m and Simba decided to portion is 156 gram food into 4 1/4 servings a day. At 10 a.m, 6 hours later at 4 p.m, yet 6 later at 10 p.m and 6 hour later at 4 a.m. He wakes me up right before 4 a.m by being a real love bug, purring and giving my love bites on my arm and laying across my arm purring. That is his way of keeping me in check so he gets his 4 a.m serving.

He has the inner sense of when it is the right time to eat food when he has his Lantus insulin 10 a.m and 10 p.m.
But I have never resticted food them. He could have eaten more than the 156 gram wet food he would have gotten do that. And yes I even gave him at occasions as little as weighed 15:grams m/d dry food, but more of because he is sucha fine man and good boy with everything.
That dry food came in handy too those times he had hypo incidents.

 

Honestly, I have heard similar. Yes, it sounds strange, but I think it's a simple explanation. He's purring, as most of our cats do when eating, and he's getting food stuck in his teeth. That sucky thing he's doing is to get the food unstuck, and since he's purring, it's amplifying and making the weird noise. Try pressing at the back corners of his jaw and rubbing a bit when he does this. If the noise suddenly stops, then you've dislodged the food and that was the issue. Was he much used to wet food before diagnosis? Is he eating one of the super low carb foods that is perhaps a little gummy?

 

he had never really eaten wet food before, and he is eating the Friskies pate which is low carb so maybe that is it. I guess I will bring it up to the vet again and see what she says, but thank you for the reassurance i feel a bit better

 

Thanks everyone for helping me through yesterday! last night at +12 he was at 5.9mmol/L so i didn't give him any insulin. I just checked it again before giving him his breakfast and it is at 4.6 mmol/L...... so again I wont give him any insulin..... not sure what this means but will send over all my info to my vet today and see what she says! will let you guys know

 

Fingers crossed that his pancreas is starting to heal. Keep testing on schedule, as this can be a three steps forward and two steps back process. For example, the pancreas can make it's own insulin one day, but still need more time to heal, and need insulin assistance again. But it's certainly a very positive sign. You've been taking awesome care of Io, and the low carb diet change can make all the difference.

 

just wanted to give you all an update with what the vet said back to me today

" Hello Kayla -

You're the first pet owner ever to send a plotted curve! How nice! Those sugar levels look wonderful, so good in fact I think he needs a lower dose. Am I correct that he's on a half unit every 12 hours? If so, you can actually just try stopping the insulin and doing another blood sugar curve in a week or so. At that time, if it looks like his blood sugar levels are normal and he's in diabetic remission, we can plan on rechecking his weight and bloodwork to follow up on those liver numbers that were high.

I do wonder if he is also having some dental pain with the grinding noises you're describing. We may need to consider an anesthetic and some dental work once his diabetes is stable. If, in the meantime he stops eating well or he seems painful, we could dispense some pain medication.

Seems like he's responded well to the insulin which is great!

Let me know if you have any other questions - "

LOL about the plotted curve.... as a previous chem major I couldn't leave the data not plotted hahaha Good news I think though! I will keep measuring his BG throughout the week and then do a curve next week fingers crossed!!!!!!!!!!!!!!!!!!!

Thank you everyone this community has been an absolute sanity saver! <3

 

Huzzah for Io! You might want to check with the Lantus folks to see if it's better to go to a .25 dose, or a micr-dose for a few cycles. It might not be necessary, but I have heard that some kitties do best weaned off more gradually from the insulin.

Either way, you and Io are awesome!

 

We often 'surprise' vets with what we can do for a diabetic cat, using the 3 keys to treatment.
1. Low carb canned food.
2. a good insulin for cats like Lantus, Levimir or Prozinc.
3. Home testing.

Well, 'another one' where it looks like the food change alone may have done the trick. Too soon to tell.

With Lantus insulin there is a little storage area called the 'depot', which slowly releases insulin over time. Depot takes 6 12 hour cycles to fill (3 days). So there may be some residual insulin 'kicking' in. The 'depot' takes about 3 days or 6 cycles to drain. Then we can see about the dosing.

Continue to monitor, record the readings on the SS and we'll go from there. If numbers start to creep back up, ask first about a dose. In the beginning, with lantus, you want to have a shoot/no shoot PS (pre-shot) non -food influenced number above 150 mg/dL (8.3 mmol).

Best to do that question in the lantus forum and let them know you only started giving insulin, switched to low carb foods, have SS in your signature, and ask for suggestions on the dose.

Excellent job you have done with Io. Keep it up!!!!!!

p.s. My cat was the first one my local shelter, and the 2 vets that work there, the shelter medical manager,7 vets at the clinic (30 years in business) where the shelter took the shelter cats when they needed more treatment to go OTJ. First one to EVER go OTJ (off-the-juice, insulin being the juice). Also called "diet controlled" or "in remission".

 

Second set of notes for Kayla and her extra sweet kitty Ion from me.
1. That 47mg/dL (2.6 mmol) on 1/23/20 was an automatic dose reduction.
2. Cats can be more sensitive to insulin after going that low.
3. Your shoot/no-shoot number should be 150 this early in the diabetes treatment. Can be lowered later. That limit is specific to lantus and a human meter combination used for testing.
4. Low BG reading may have 'jump started' Ion's pancreas. Keeping our paws crossed for Ion.

My only 2 comments are that Kayla should have included the US number in the thread header, to get more eyes on you. Otherwise, fantastic job folks! Thanks for all you do. US number in mg/dL is world number in mmol multiplied by 18. It's on the US side of the SS if you look closely. Kayla, could you please drag that tab for Ion's SS over to the far left. The far left tab is the first one we see when we click on the SS link in your signature. Since most of us are in the US, we like to have that tab of the SS open first.

p.s. I'm in and out with helping here on the message board. Health issue I'm dealing with, so can't be around as much right now. I did want to check in on Ion today, especially after yesterday's excitement. Everyone that helped did a good job. Better than good. Excellent in fact.

 

Hi Kayla,

From personal experience I've found out that a visual tooth exam may not tell all. My cat went in for a cleaning because of some tartar build up and after having xrays, it was discovered that some of the tooth root was being absorbed. She ended up having 3 extractions. I don't know about your cat, but a 'visual dental exam' is a quick glance as Freckles is not exactly the most cooperative cat at the vets.

 

Sienne and Gabby (GA) has suggested that there are many more experienced users of Lantus/Levimir on the Lantus ISG. You may want to think about posting over there.
Lantus / Basaglar (glargine) and Levemir (detemir)

In case you get low BG numbers again.

 

Thank you x 100000000000!!!! I made the change to my SS thanks for all your help!

 

Hi All, wanted to give an update in case anyone was interested. I have not given Ion any insulin since my first curve on the 23rd. I checked him a few times and his readings were all below 7 mmol/L (126 mg/dL), and today I did a new curve (the second tab on this file). I'm sending this off to the vet and hope for good news. I'm not sure I totally understand how he could go from having BG of 300-500 mg/dL the first week of Jan (especially since he wasn't eating then) to now having such better numbers, but I will absolutely not complain haha! Fingers crossed this means we won't have to go back to giving any insulin right now, and that when i get him back into the vet for more blood work his numbers that were high have come back down. Also once we get the BG under control I think we will do some more checking on his teeth, potentially do an xray, although he isss eating now so maybe we don't have to.

paws are crossed! Thank you all for the love and support!!

 

ION!!!! What are you doing?!?

Well Kayla, with that 28 mmol/L (504mg/dL) BG reading you got this morning, it does look like Ion still needs insulin. Darn!

What probably happened is the Lantus insulin "depot" storage area drained. Hard to tell, since you haven't been testing every day.

Some of the dates look funny, wrong type "funny", to me.
For instance, you have 1/24/20 and then the next row is 1/8/20. and the row after that is 2/2/20.

Best if you can test every day, at least 4 times a day. Twice in each 12 hour cycle.
AMPS morning pre-shot test (or morning cycle test if not getting insulin)
PMPS evening pre-shot test (or evening cycle test if not getting insulin)
Then you need to get some BG tests in the middle of the cycle, to find the nadir for your kitty. It's different for every cat, but MOST cats reach their lowest point in the 12 hour cycle somewhere in the +4 to +7 hour range from that PS (pre-shot) test time. Can be early or later and it may not be the same every day.

Do you feel comfortable giving Ion a tiny dose of insulin? A dose of 0.25U is what I think she needs right now. Up to you what you are going to do. Are you home to monitor today?

Check with your vet, to help guide you and give a second opinion on what we tell you.

 

Oh sorry no no this was from the first vet visit when we found out he had diabetes. His readings were all really good right now

 

I also got good news from the vet this morning based on the curve i sent over

" That curve looks great! All those blood sugar readings are normal so it looks like he's in remission. Just continue with the low carbohydrate canned diet and monitor for signs of increased appetite, increased thirst and urination. He may start needing insulin again in the future, sometimes this happens when the cat gets stressed from another disease. Now that you have the glucometer, you can spot check him at home now and then, especially as he did not have all the classic signs of diabetes. Any number between 3.5 - 9 is considered normal. Also just keep the insulin in the fridge, it's good for 3-6 months when it's refrigerated, in case he needs it again within that time period.

I think it would now be a good time to get him back for a follow up on those liver numbers that were high. We should get a weight at the same time and make sure we are feeding him the right amount. I can also recheck his mouth at the same time.

Let us know when is a good time for you to bring him back. Glad he responded so well to the insulin!"


IM SO HAPPY

 

We're happy for you too Kayla and Ion! Fantastic news! Good going Kayla and extra sweet Ion!

Here are some tips to help Ion stay OTJ (off-the-juice, insulin being the juice)
1. Never feed dry - not even treats. If you change wet food types, be 100% sure the new food is also low carb and same low carb % as your current food. Some cats are very carb sensitive and an increase from 3-6% to 8-10% can spike the BG’s. Don’t feed if you aren’t sure!
2. Weigh every 2 weeks to 1 month to watch for weight changes. Too much of a weight gain can cause loss of remission. Too much of a weight loss alerts you to other issues, such as hyperthyroidism.
3. Measure blood once a week, indefinitely if possible. You want to catch a relapse quickly. Some people only do checks every 2 weeks to a month. BG checks can sometimes alert you to other issues.
4. No steroids or oral meds with sugar - remind your vet whenever giving you any medication. Always double check. (Steroids may be needed for other medical issues. But remind your vet your cat is a diabetic, diet controlled.)
5. Monitor food intake, peeing and drinking. If increasing, a sign of losing remission. Or another medical condition like Hyper-T or kidney disease.
6. Regular vet checks for infection such as dental , ear or UTI. And get them treated quickly!
7.Continue to ketone test even if your cat is OTJ. Ketones can develop if the cat’s pancreas is not producing enough insulin, or burning off too much fat if your cat is not eating properly and other reasons.

If your cat does fall out of remission you need to be more aggressive and resolve issues/ back on insulin as soon as possible as the window for a second remission is tight if any. Pancreatitis, hyperthyroid, dental issues are the most common reasons cats fall out of remission.

"Once a diabetic, always a diabetic."

p.s. You might want to fix your SS (spreadsheet) as that is the second item we look at after we read your post. With the wrong information on the SS, that is why you got the feedback from me that you did this morning.

Please.