Help please Random low

Hi, so we got a bit of a low number tonight before dosing 12.8 this is the lowest he has been at night since we have been testing and I’d say since he was diagnosed as it’s the first time he’s been acting normal at night time. My wife gave him his standard 4u as we have been doing for the last 3 weeks but know I am worried we may have overdosed him as we are normally shooting from mid 20s. What is a normal high in the afternoon before people shoot? If you get a sudden drop in the afternoon/morning should you shoot lower or not at all? When I do his +2 test tonight if he is going really low what should I do to stop him crashing to dangerous low levels?

 

Human or pet meter? On a human meter, we usually say not to shoot numbers below 200 (around 11.1 in your measurement units), a little higher if you are using a pet meter. As you gather more data and know how he "behaves" on the insulin, you can push that no-shoot number lower. You should be fine shooting the 12.8, but definitely get another test in tonight to see where he goes from there.

I am somewhat concerned about that starting dose of 4U-- it's quite high, especially for a cat that is very underweight. Very glad you are testing to keep him safe!

Normal numbers for a human meter are roughly 2.8-6.7, 3.8-10 on a pet meter, so you want to keep him from dipping below those ranges. Post for help, too, if he seems to be "diving" quickly-- not yet below the cutoff, but going down more rapidly than usual.

HERE is a sticky on handling low numbers (all numbers will be in the US measurement system, just divide by 18 to get the equivalent numbers on your meter). You also might want to start poking through the stickies on the Lantus forum-- lots of information there!

 

Thanks for the info, it is a human meter. we started at 1U and gradually went up over about a 6 week period but before he was getting vet tested so I don’t have any data from those lower doses. Is it adviseable to drop his dose to get those numbers for safety and if so how low should we go? Do you know at what numbers they will start to gain weight again? Does he need to be in that 2.8-6.7 range? Or will they start to gain some weight back in higher numbers?

 

Hi, I live in Sydney
A lot of cats have lost weight when they are diagnosed with FD and they are often really hungry ...but they can also have lost their appetite ...so every cat is different ECID. Until they start to get back into lower numbers they probably won't put the weight back on. This is because their bodies can't absorb all the nutrients for the food and they need extra food to compensate. Do you feed several smaller meals during the day? It is not necessary to just feed morning and night. And it is better for the pancreas to have several smaller meals. If you are not at home a timed feeder is great.

It is hard to say if you are giving too much insulin. Too much insulin can look like not enough insulin. You need to get more data in the SS. Try and get some more tests after the evening shot if you can. If the vet was doing the testing and increasing the dose, he would have based the increases on the preshot...whereas we base the increase on the nadir...or the lowest point that the insulin takes the BSL. Also going up in 1 unit increments is too much and it is easy to go past the best dose. Going up by 0.25 unit increments is far safer and better for the cat.
Are you using an insulin pen or syringes?
How is the drinking and peeing. Are they better or worse?

Are you able to find out from the vet what some of his BSLs were when they tested?

I would recommend you start posting regularly (daily) on the Lantus page. You will get lots of help there from people who use Lantus (glargine) every day. Here is the link
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

 

We are using syringes that only go up in 1 unit increments currently. we just got his +2 and he had spiked up to 26 is that what people are referring to as a bounce? I.e we’ve over dosed him so his body has counter acted by producing huge amounts of glucose? We are hoping to get his nadir a bit more regularly but my partner can only get home every couple of days in her lunch break to get it. He still is drinking and weeing a lot and has a huge appetite he is never not hungry.

 

He is probably bouncing from the perceived lower than normal number he got at PMPS.
Cats bounce when they drop fast, or when they drop low, or they drop lower than their body is used to. Their body thinks it has to save itself and they dump regulatory hormones into its system which sends the BSL skyrocketing. Some cats are bigger bounces than others. My cat Sheba was a huge bouncer and diver. It can be very frustrating.
Make sure he is drinking plenty while his BSL is high.
If he is hungry give him more food.

I used 1 unit syringes and used to dose in 0.25 increments. I used a magnifying glass and used to eyeball it. It is just a matter of getting used to it. There are no 1/2 unit syringes here in Australia but some people buy them from overseas. If you are interested I will find the address.
Are you following one of the two protocols we have here...the tight regulation protocol or the start low go slow protocol?
I think your best bet would be to start posting over on the Lantus ( glargine) page as I mentioned above.

 

I agree with all Bron has said above. It's really hard to say whether the current dose is too high-- just not enough data-- so I wouldn't recommend reducing the dose immediately, he may need that insulin. The Lantus forum has a couple of procedures for systematic dose changes, as well as a large number of very experienced users that can help to figure out where Fred should be.

It does take a fair amount of testing to figure out. You don't have to get his exact nadir every day, just do what you can to fill in the puzzle pieces on the spreadsheet. If you can get readings at different times in the first half of the cycle at night and then occasionally get a +6 or +7 during the day, that will give a pretty good picture of what a particular dose is doing for him.

It's frustrating when they're hanging out in high numbers like this, and still drinking/eating to excess. But it wil get better, it just takes time, especially with a bouncy kitty-- bounces can really cloud the picture and they can last up to three days! In those cases, in the early days, the cat can be responding well to insulin, but still basically spending all of his/her time in high numbers anyway. Testing regularly at home really helps then, because you have a much better chance of catching the occasional low than you do bringing him to the vet for spot checks.

 

thanks for the advice. we have been following the start low go slow protocol but after finding this site decided not to go above 4U without more information (wish id found this site earlier) so at the moment we are just trying to keep things constant and the same and trying to get data. Im fairly certain we overdosed him last night with the 4U as he was crazy all night tearing into anything that resembled food - bin, cupboards, anything he could get into that might have food and woke us up all night he also drank every bit of water he could find it was probably the most possessed id seen him. So my question is if we get another evening reading around a 12 should i shoot him less? like 2U? or continue to keep things constant at 4U. will it do any harm to shoot less?

 

Giving too much insulin does not usually create symptoms like you described he was last night....racing around and starving and thirsty.
I would say at the moment he is bouncing from the lower than normal PMPS he had last night and this could go on for 3 days (6 cycles). Keep testing whenever you can and document in SS as we always look at the SS when helping you. Try and get the previous numbers from the vet if you can as they will help.
If he's starving, feed him more and make sure there is more than enough water out for him.
If he is 12 (216) again, yes shoot the 4 units and get a +2 to see how he is going. Then evaluate if you need to test further during that cycle.
If you are concerned about a low/ lower preshot than you are used to, stall but no not feed and post for help.

If you give less insulin....say 2 units.....it could make all the symptoms worse IF he actually needs the 4 units.
So at this stage I would:
Stay with the 4 units until the bounce clears and he comes down to lower numbers and we can see what his 'real' numbers, not influenced by the bounce, are.
Give him extra food if he is starving
Make sure there is plenty of water for him to drink
Test every preshot and during the cycle to gather data.
I would again suggest you start posting on the Lantus (glargine) forum....there are many experienced people there who use Lantus every day and are used to all kinds of scenarios. Link this post to your next post over on the new forum for continuity.
Keep asking questions...it is a steep learning curve in the beginning but you will soon be very knowledgeable about FD.

One other thing.....how old is your glargine? Do you keep it in the frig, (not in the door of the frig.)
Do not roll or shake it before use.

 

Thanks I will do how do I link it in the glargine section? We just got a new glargine about 2 weeks ago as we thought the first may have been faulty. We store the insulin in the fridge but we have been storing it in the door, no one ever mentioned we couldn’t before. Have we ruined it storing it in the door?

 

There wouldn’t be much data we ran him on a dose for a week then got him tested midday (should be his lowest?) then if he was really high the vet would put him up and we would go back a week later and repeat. We were also pee testing him everytime he went looking for any drop. It wasn’t til we reached 4 units we started the home testing cuz the vet was concerned it was a high dose. I’m a little worried that we may have missed his ideal dose going up without consistent dailty data.

 

The insulin will be fine in the door for that short time.
To link the posts go to the top of this page and copy the URL and paste it into your new post in the Lantus page.

Those tests that were taken by the vet in the middle of the day will be useful to see how he was going early on.
You have come to the right place to get it all sorted out. It will take more than a couple of days but you have taken the first steps. Going up in 0.25 increments is the safe way and not miss the best dose.
See you over on the Lantus page!