Hypo episode--help please!

Hi all,

Spike is currently on 1u of Lantus BID. He's been acting funny tonight--running around like he's seeing things we can't see (I know cats do this all the time, but it was different), kind of convulsing (but with his eyes open--he sort of looked like he was about to barf but that' s not what was going on) and was just really riled up in general.

It was time to feed him and give him his shot, but since he was acting weird, I thought I'd test his BG first. It was a 37. I didn't administer the shot, obviously. I called the vet on call tonight but they're all busy right now and I'm waiting for a call back. I fed him the can of food he normally eats and he snarfed all that down. Then I fed him a second can with some Karo syrup on top and he snarfed about 3/4 of that down. I tested his BG again about 15 minutes after the first test and it was 33 (this is while he was eating the 2nd can).

Now he's stopped eating, has calmed down, and is a little twitchy but doesn't seem to be spazzing out. I'll test his BG again in another few minutes. Any advice? How long after eating does BG start to go up?

 

It takes a few minutes. Test him in 10 or so.
Be right back
Carl

 

I posted in Lantus ISG...hopefully someone will be along with Lantus experience.

 

Hi!

Breath.

OK, you need to get some carbs and sugar into Spike. Do you have high-carb food? If you spoon off the gravy, that's where most of the carbs are.

You need to keep him hungry, so try to keep away from giving him LC food if you can avoid it. You want to make sure he still has an appetite for the carbs.

THe general rule is to feed, and retest afte 15 minutes.

I'll go post over in Lantus to get someone more experienced to help more.

 

ok, back. can't handle an emergency over a smart phone...

carl

 

Rub karo or honey on his gums for fast absorption.

 

how is he doing????
I had my Sugar Bean at 27... we did small high carb treats, and lots of honey over bread w/ milk - small amount just enough to get her to eat, did not want to get her too full too fast
please let us know

 

OK, I just read through all your previous posts.

Here is some info that can help all of us give better advice:
1. When, exactly, did you give him his shot?
2. What are all of the BG readings do you have from the last 12 hours?
3. What is all of the food you have given in the last 12 hours?

Also: Can you please let us know what food you have? What are you normally feeding, and what else do you have in the house?

Karo on top of food does wonders to get the BG up quick, but it can also wear off kinda fast.

We'll stay here with you.

 

Thanks so far everyone.

I gave him two cans of his LC wet food, but I also put some Karo syrup on top. He ate a fair amount of it. He's stopped eating after two cans of wet food (double what he normally eats) and a few bites of another one. I just retested him and it was a 37, so there's really no change so far.

I think he's probably full at this point--when I tested him, my first instinct was to get him to eat ASAP so I just gave him a bunch of food. I'll try feeding him some more corn syrup and see if he'll eat that.

 

What was the bg this morning when you gave the insulin shot? Are you testing before each insulin injection? One of your previous posts said that you are not regularily testing bgs.

Are you measuring 1 unit correctly? It has happened before that a newbie misreads the markings on the insulin syringe and is actually giving the cat too much insuiln. 1 unit in a U100 insulin syringe looks like this.

Corn syrup doesn't last too long in a hypoing cat. Best to give high carb canned food, even dry food along with some syrup.

 

Spike's Mom,
Do you have plenty of BG test strips?

 

Please get a test that's about 20 min. after your most recent test. You're going to want to repeatedly test and feed.

Also, do NOT give as much food as you've been giving. You do not want to over feed your cat and have your kitty puke. From now on, small amounts of food -- no more than a teaspoon.

Do you have any high carb food? Anything with gravy? If not, is there anyone who can pick up several cans for you? It's not critical if you can't get any, it just makes things easier.

 

rub it on his little cheeks if he is too full.. would he take small treats? ice cream from your finger?

 

1. The last shot he had was at 7:30 this morning, so 13 hours ago.
2. The only BG readings I have are from just now (37, 33, 37; all in the last hour)
3. In the last 12 hours he's had a mid-day snack that was 1/2 a can of walmart special kitty wet food (I couldn't tell you which flavor offhand because I have a bunch of them), then 2 cans of food that I just now fed him.

I have more of that wet food, as well as some assorted dry food that he no longer eats (some IAMS diet food from before all of this started, as well as some Science Diet regular indoor cat food).

 

I didn't test this morning. After tonight...yep, think I'll be doing that more regularly!

I am measuring the 1 unit correctly, although I do appreciate you asking because it's definitely a crazy small amount that might confuse people!

Yep, although not too many lancets on me at the moment.

I'll work on getting smaller bits of high-carb food in him, although I'm not sure how best to do that. How carby are Temptations treats?

 

Vanilla ice cream available?

 

Great!

Hypo at +13 is really late... You really, really, really need to test more. (a spreadsheet would be nice too, there are instructions in the Quick Start Guide in my signature), but all of that can wait until we get through this.

Some of the Special Kitty flavors are pretty high carb. I know you don't know which you gave him, but which flavors do you still have?

 

Only some mint chocolate chip, which I suppose I should not give him because of the chocolate.

Just now he ate the Super Supper Dinner and Chicken & Tuna. I also have two more salmon ones. It looks like those flavors are the only ones I have left.

I tested again and my meter said "LO" which apparently means below 20, but when I was working on getting a drop of blood out for the strip to catch, it looked a little serum-y (if that makes sense--it wasn't all blood but also something clear-ish). I'm going to try to move to a different spot and see what happens.

 

how about some yogart>

 

So the other big question: should I take him out to the emergency vet? I'm about half an hour away from them, so this is no small trip for me when I have class at 8am tomorrow. They called me back and told me that they would normally ask to see him, but that since I'm not nearby, I could monitor him at home if I wanted to.

If I did bring him in, does anyone have any idea how much this might cost? Obviously, for something treatable like this, I'd take him in if I really needed to, but if I can probably deal with this at home, that would really be better.

 

did you get another reading yet??

 

An ER visit isn't going to be cheap, and you really can do this at home, these folks will stay with you all night if they need to. Trust me on that one, if we have to we will tag team all night to make sure there is someone walking you through this. You're gonna do great at home with this.

Mel, Maxwell, Musette & The Fur Gang

 

Regarding the vet: You ultimately need to do what you are comfortable with. I'm not sure if there are any good guidelines to give you, but one key piece is:

How is he behaving now?

While I'm at it, you can re-use the lancets as many time as you want in this situation.

 

49! Getting higher, finally!

He's going to get tired of me sticking his ear eventually. Other than the lancet getting dull and hurting more (and he doesn't seem to care yet), is there any danger to using the same lancet several times in a situation like this?

 

I have before and have forgot to change it.... dont like to but that vrs not having any, I would use it!!!
and GREAT NEWS!!!!! YOU GO GIRL!!!!
GOOD JOB WITH YOUR BABY!!!
:RAHCAT

 

He's actually behaving pretty normally. He's stopped running around and is kind of just hanging out in the living room with me. He doesn't seem totally relaxed, though, and he's breathing relatively quickly (although not panting). As I typed this, he just walked over to eat some more food.

In comparison to an hour and a half ago, when he dashed across the entire house and threw himself on top the kitchen counter (he has NEVER jumped up there; he's a Maine Coon and not vertically-oriented in the slightest), he's behaving MUCH more normally.

Ha, perfect timing with the lancet answer, since I was asking that just as you posted!

 

55!

Thank you guys so much for your help so far. You are infinitely more helpful than the vet on call, and this is also allowing me to sit at home and work on my readings for tomorrow in between BG tests.

 

GREAT!!!

BUT you need to keep vigilant. You are probably seeing the effects of the Karo, which will wear off very quickly. Given that he was symptomatic, you should keep feeding small doses of karo on small dolups of food until his numbers are rising again. "Small" is usually ~1 teaspoon.

Test again in 15 minutes.

If you could get some high-carb food somehow, it would help make this more stable. You do have the dry, but that can take a very long time to kick in.

I just read your last post. You need to only be feeding him Karo + Food in very small doses right now. You DO NOT WANT him to eat too much LC and fill up. Once he is out of the woods for at least 1 hour, you can start to relax a little.

 

Hopefully, things will settle down here in the next 30-60 minutes. When you are ready, let us know, and we can start talking about what you might want to do tomorrow and going forward. I am very scared that your little kitty may be trying to go off of Lantus, or at least needs MUCH MUCH less, and you could inadvertently kill him with this "medicine".

 

I'll keep y'all updated, but I wanted to respond to this--even if he's back to normal by tomorrow morning, I didn't plan to give him his shot. I assumed it would be much better for his BG to be high than for this to happen tomorrow while I'm gone.

 

Back down to 43, although I've figured out I can get him to eat com syrup by sticking a kitty treat in the middle of it. Is there any other human food that might be good to feed him in lieu of corn syrup, if it wears off very quickly? I don't really have access to any high-carb cat food right now, and it sounds like I don't want him to eat a lot anyway.

 

Bread--very high carb..can you put karo on it and put it in milk

 

You're not past tonight yet so let's not anticipate the morning.

Low numbers like this on Lantus can mean a VERY long night. You are going to have to stay on top of your cat's numbers for several more hours, 8 AM class or not. A hypo event on Lantus can last for 16+ hours. Put a pot of coffee on.

Adding Karo to LC food is fine. The LC acts to increase the duration and the HC bumps the numbers up. It's like feeding HC food -- solids + gravy.

 

It's great to see Sienne chime in, she has more experience than the resut of us put together.

The Temptation Treats look like a pretty good option for a "High Carb" food.

So long as you are <60, I would suggest sticking with the karo+temptation or karo+LC if it is working.

Watch out for the milk if he has any issues with it. You don't want him vomiting (my S'mores will vomit immediately after happily lapping up milk)

It is probably wise not to give the shot in the morning if you can't monitor during the day tomorrow, but you do need to get back on the bandwagon eventually.

If it were my S'mores, here's what I would do:
1. Setup a spreadsheet and fill it will all of the data you do have, so the people here can be much more helpful
2. Test as many hours of the day and night as you can for the next 24-48 hours to get a sense for what he is doing
3. Tomorrow (Mon) evening, at least 2 hours before the intended shot time, I would post all of my data onto the Lantus board here and ask for advice

There are a lot of different ways this could go. You could find that your little one is already ready to be off the juice (OTJ), and the numbers stay "low" (say <150, ideally <120), and you stop shooting. You could also find that your dose was about right, and he shoots through the roof in what's called a "bounce". In that case, this low number just earned him a reduction to 0.75, but you will clearly need to monitor much more closely. Many of these cats go OTJ very quickly when they are finally ready (dropping 1u in 3 days is not unheard-of)

 

Yep, had some of that! Gave him some and he's nibbling on it.

I'll keep an eye on Spike's BG as much as I can until this is resolved (I mean long-term, not just tonight), but tomorrow is going to be a problem--I have to be at school all day long (8am-6pm) and there is absolutely no way for me to get out of any of it, unfortunately.

 

Dry food or Temptations take too long to work. The dry stuff also hangs on in a cat's system for a long time. Canned food is better -- quicker in and quicker out so you know what you're dealing with.

I would not use milk -- many cats are lactose intolerant and I doubt you want diarrhea tomorrow.

A great deal depends on what's going on tonight with respect to what one does tomorrow. In the case of a hypo, often a cat is very insulin sensitive the next day and skipping the shot may be indicated. Where numbers are in the AM may be a better means of dictating the course of action. We're talking 10 - 12 hours from now. Given that this could last for 16+ hours, this could be a moot point.

I am going to suggest that you start to home test on a regular basis. This was only very good luck that you tested and figured out what was going on. If you happened to fall asleep early and your cat's numbers continued to go down, this could have been a very different scenario. I hope it is a good lesson in terms of the importance of regular home testing as a means of keeping your cat safe. You have been shooting blind. It is a bad practice. I doubt that you would give yourself an insulin shot without knowing what your BG level was.

 

I totally understand the need to be away during the day. If you look at my spreadsheet, you'll see that I have much less data than people here would recommend, but I work long hours. You will also see lots of measurements in the early evenings, some very late nights, and that S'mores went from diagnosis to OTJ is 3 weeks. Every cat is different, and 3 weeks is extremely unusual, but it can pay off hugely to put in the time.

Looking at the comment just above: Have you tried putting Karo on a little LC food?

Also, how are the numbers looking?

 

We're at 63 now. He seems to be pretty full, so he's ignoring the wet food & Karo, but he'll still eat Karo with a treat.

ETA: his poor ears! He looks like he got in a catfight.

 

Great, again! It's not unusual to see the numbers bounce down and back a few times before shooting up for good. That's why we like to see a solid series of rising numbers before we relax at all. It would not be unexpected for the next reading in 15 minutes to be back in the 40's, or up at 100.

For the ears: It really helps a lot to put pressure on the spot after you get the blood. 10 seconds of squeezing is usually enough to stop the bloodflow, prevent bruising, and keep the ears looking pretty :roll:

 

Hey All: Ideally, I would crash soon. PM me if you are around and willing to take over. Otherwise, I'll stick around until we're good!

 

I'll have to try that next time...although it may be too late this time around, haha.

 

you're getting a lot of help, kbean, and i just want to make certain that sienne's posts are not getting lost in the flow. you're getting good help from sam, but don't miss sienne's. make sure to pay attention to everything she's saying & answer her questions - she has years of experience at this.

 

Yep, I'm paying attention to everyone--I'm trying not to miss responding to any questions that pop up but it might happen my accident.

80 at last test, btw!

 

Spike's Mom (can you tell us what to call you besides that?)

Great advice from Jullie. Sienne has dealt with this situations lots of times, and she understands the insulin you are using on Spike extremely well. Make sure and reread what she has posted so far.

I've let Sam know it's okay to get some sleep, but I will be here, and others are here as well. (Thank for all the help Sam!)

Can you tell us how Spike is acting?
80 is good.
Carl

 

80 is great, and I am going to sign off. You are in good hands.

Looking back over Sienne's posts, one thing that I want to make sure did not get missed:
Try to avoid milk, if you can. We don't want to create new problems!

I'll check in in the morning to see how you are doing.

BTW, where are you? (in particular, what time zone?)

 

He had a little bit of milk, but not much. Most of it got soaked up by the bread, which he was then not interested in eating.

We're in IL--central time zone.

Oh, and my name is Kathleen

 

Eep--last test was 30. Gave him some more corn syrup.

 

Kathleen,
What you are most likely seeing is related to the syrup. He gets a boost (like up to 80), but it doesn't last long. What we are hoping for here is for that food he ate to kick in, and make his number rise two or three tests in a row. As long as he keeps dropping back down, you have to keep monitoring him closely and trying to get the sugar up. But, you can't make him eat too much at a time, as people have already said. The trick is keeping him hungry enough so that when you need to make him eat, he's still got room for food, and doesn't barf it up.
Just rub the syrup on his gums if you can, or let him lick it off your finger. Honey and/or maple syrup can be used if you are low on karo.
Carl

 

This could be a long night for you. Do you have anyone to go to the pharmacy and get more lancets so the ones you have don't get too dull? I'm worried if you have to keep testing that he'll start to have a problem
with it if the lancets aren't sharp.

What Carl is referring to, we call "wash, rinse, repeat". So you test, feed the gravy/karo, test and repeat until he is high enough and is not turning around on you.

 

Lol, Marje -- it's "lather, rinse & repeat."

As the HC wears off, numbers drop. This is to be expected with a cat who may be experiencing a hypo event. It can take quite a few hours for the numbers to come up enough on their own to stabilize.This is why you need to repeatedly test. The good news is that the HC does wear off and you know where the numbers really are.

You are going to have to keep testing and feeding.

 

Just tested again. 128. We'll see how much it drops again after this--hopefully not too much but I know we're not out of the woods yet!

 

128 is a great number! You are doing great!!! :RAHCAT Praying for you all!

 

Up to 139 this time!

Question, though--Spike is still breathing really rapidly and he's also pretty warm. His pawpads and nose are bright pink (they're usually pretty beige) and he's sweating a little. Should I be worried?

 

How rapidly is he breathing? Does it look like he is having a hard time breathing? Would you consider it panting?
Don't suppose you can take his temp?
carl

 

He doesn't seem to be using trouble breathing. His mouth is closed so he's not panting, but he's breathing pretty rapidly. His normal respiration rate is fairly high to begin with. He's mostly just sitting in my room and napping right now and I put the fan facing him.

I can't take his temp. The only thermometer I have is mine, and it's rubber so I don't think it would work well anyway.

 

Next time you test him, check to see what color his gums are.
Just an overall "warm", body or ears is not are very reliable indicator that he might have a fever, which is why I asked about a thermometer. Sometimes rapid breathing can indicate some sort of pain. It could just be he's had a rough day...
Carl

 

His gums are...I dunno, gum-colored? Pink, darker around the teeth? Honestly, I'm not sure what to look for.

He's a very talkative cat, and he generally lets me know when he's uncomfortable or in pain. He's being fairly quiet now, so I think he's okay there (but I guess I can never be sure). It could just be the tough night he's had--he's also batting at me and biting me when I get near him, which is VERY unlike him unless he's being playful, which he's not right now.

I have to try to get some sleep, so I'm going to sleep for a bit and set my alarm to check on him a few times in the night. He's been consistently over 100 for more than two hours now, so I'm feeling better about his BG. I'm also leaving some dry food out for him.

 

you can leave him out canned food and it will be good for 12 hrs/ish. mix in a little water and it won't get crusty.

the dry food will send him high and he'll stay high for too long. go ahead and use the canned food and it will be fine.

 

Got it. I left some wet food out instead.

I'm kind of afraid to go to sleep but since I'm sitting here just kind of staring at him at this point, I'm not sure being awake serves much of a point.

 

Kathleen,
If you had said "dull grey", I might have been alarmed. His gums are "normal" - a good sign. Blue or grey would have meant his breathing rapidly indicated he wasn't getting enough oxygen. I was just trying to remove the "bad" things from a mental checklist.
Sounds like he's had enough poking for a while.
Take a cat nap. You did really great tonight! Keep us posted until you have to leave for class.

Carl in SC

 

Will do. Again, thank all of you guys SO much for your help.

 

by the way, i do want to reiterate what sienne said earlier. you were very lucky tonight that this is coming out with a happy ending. it's not your fault, but now that you know, please make sure and test your kitty before every shot and get a mid-cycle test. mid-cycle numbers tell us what the dose needs to be.

knowing what i know now, i don't know how any vet sends a cat out on insulin without having them be hometesting. it scares me to think about.

we'll help you. promise. it's learnable and then you'll know your little one is safe.

hugs!

 

Good morning Kathleen,

I hope you were able to sleep some after all that excitement last night!

One request: Assuming Spike's numbers are OK this morning, could you please go back to the first post in this thread and edit it to change the icon? With a 911, people will keep jumping in to make sure everything is OK.

Second request: PLEASE TEST AND POST! I'm hoping that last night made it obvious to you why the people here are so adamant about home testing, but I say it again because too many people do not learn the lesson even after scary nights like you just had. You've already done the hard part, which is learn how to test , so now all you have to do is keep testing and post here for advice. You need to test before every shot (what we call the "pre-shots", either AMPS or PMPS), and ideally 3-5 more times during the day, most ideally in the +4-+8 range after you shoot, but it's better to have some measurements around the shot than nothing at all on those days where you just can't get mid-cycle measurements.

When I say "here", after you get your spreadsheet up and running, I would suggest that you move over to the Lantus forum for dosing advice. Please read the LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ... sticky to get started.

 

Icon changed.

Yes, I did get some sleep, thank goodness. Spike got up this morning right as I did and went to his food bowl to eat the food I left out for him before I went to bed (I don't think he ate any last night). He wouldn't let me test his BG when he had just walked up to the bowl, so the first number I was able to get was about 15 minutes after he'd started eating, and it was a 183. Oh, and he's no longer breathing as quickly, and his pawpads and nose are back to a much more normal color. I bet it was the stress.

I don't know if 183 is generally a shootable number or not, but given last night's events and the fact that I won't be here all day, I'm not giving him his shot (unless someone responds otherwise on here before I leave for school). I'll call the vet today and talk to him about it. Like I said, I won't be able to get many numbers today, but I'll try to get as many as I can this week and start posting them.

 

If it were me, I would not shoot this morning.

I you can get even just a measurement 1hr before your normal shot time tonight, and then the pre-shot value, we can make a better decision. If you get measurements at +1, +2 and +3 after shoot, you can get a good idea for where Spike is headed. When I could not get measurements during the day (which is most weekdays), I made sure to get some extra measurements at night. I found the "-1" measurement was very helpful to me on those low data days. When I could measure on the weekend, I made sure to get a full cycle (measurements every 2 hours or so over 12+ hours).

Unfortunately, a few measurements spread out over the week really does not help much. Insulin is a hormone, and Spike's body is relearning how to control that hormone. Those swings happen over a few hours, not over days, so you really need to get clusters of data from a single "cycle".

Please post tonight so that we can help.

And be happy. Those low "green" numbers as we call them mean that Spike's pancreas is healing, and may be able to take over completely eventually! Published studies have show remission rates as high as 85%, so this is not a pipe dream at all (if you follow the protocols here).

 

Good a.m. Kathleen and wonderful Spike!!!! goood boy and mommy too!
Glad to know that his numbers are up and he is feeling better. Keep us posted. My Sugar Bean went OTJ within a month, it is possible!

 

I found this above in one of your previous posts (Aug 14th). I have to say, this is the SCARIEST THING I'VE EVER HEARD OF a vet say. I don't understand how vets think they can safely treat with insulin based on occational readings at the vet, but just sending you home after a VERY LOW reading in the vets office with a random change in dose is just horifying to me. Please be careful and use your own judgement with whatever the vet tells you going forward. Most vets just don't have enough experience with FD to give good cronic advice. They are a lifesaver in emergency situations, but inbetween, they can sometimes do more damage than good.

 

Newbies are advised not to give any insulin if the bg is under 200.

Please start testing bgs before giving the insulin, even if you are running late for something. Blindly giving insulin without knowing what the bg is can result in a hypo, like you just experienced, or worse.

 

I would not give 1u tonight if BG is over 200. Since he just had a pretty crazy hypo incident on 1u, it is too much insulin. If numbers are over 200, and they likely will be (when cats experience a hypo episode like this their numbers usually go very high afterwards because their livers dump glucose into their blood. This usually clears within 24hours, sometimes a little longer), I would give .5u of insulin, maybe .75u at most. Since you haven't been testing regularly, we don't really know what his dose should be at, so I think it would be safer to drop to .5u and hold it for a few days to see how he does on it. That means getting some mid-cycle tests in. If he's going into remission, the dose may need to be lowered rapidly. If he's not, it can always be raised back up to .75u once your tests indicate the need for that much insulin.

Most cats do need to be weaned off insulin if they are going into remission, rather than suddenly removing it. Given the dangerous advice you've received from your vet already (being in the 40s-50s at the vet is INSANE, because numbers are not only inflated because of vet stress, but they also use a meter calibrated for felines, which means those numbers are actually lower than you think--a 50 on a human meter is about an 80 on one calibrated for cats), I am worried that they will advise you to stop his insulin completely. This is not recommended because doing so could send him slowly climbing into high numbers again and force you to start treatment all over again. You need to shoot lower doses (.5u, then .25u-.1u) for a bit to help the numbers hold.

Discontinuing insulin may seem very tempting, especially when you're very busy and the vet is recommending it. However, this is not in Spike's best interest.

I would really urge you to set up a spreadsheet. The link is here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0 (if the spreadsheet won't copy, the workaround is here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130)

Please also review the dosing protocol for Lantus: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. There are many very experienced people in the Lantus forum that can help guide you into remission. My vet did not give good dosing advice, so I learned how to dose correctly there, instead. And regarding testing--I work two jobs and go to grad school, and my vet was telling me that it wasn't necessary to test daily, so I was very lax with it in the beginning. That was until I did my own research and realized that the 80+% remission rate was ONLY attainable by following the protocol, and that the protocol was also the only safe way to administer insulin. It seems like a pain to get those tests in the beginning, but the payoff of doing it the right way now means getting your cat off insulin and then you only have to test once every few weeks. If your schedule is anything like mine, then getting to this point sooner than later is a goal to work towards. And the added bonus is having a healthy and safe kitty.

I hope to see you over in the Lantus forum!

 

I'll test him tonight around 7:00 Central Time and let you guys know what the number is. Regardless, it sounds like I probably shouldn't shoot tonight (or if I do, a smaller amount).

I'm still waiting for the vet to call me back, so we'll see what he says. If he recommends going cold turkey, I'll probably try to wean Spike off of it instead. How quickly would that generally be done? Is it sort of standardized, or generally just going by the cat's BG levels?

In terms of home testing, I can definitely start doing that. However, on weekdays there's really no way for me to get numbers during the day. I can definitely do pre-shot AM and PM numbers and up to about +4 hours post-shot in the evening, but that's all I'll be home for. Weekends are obviously much more flexible. Should that suffice?

- Kathleen

 

Whatever you can do will have to be enough. I was successful with exactly the schedule you listed above.

As for "weaning off", the people here generally follow a protocol called the "Tight Regulation" protocol, which uses a set of well-defined rules to adjust dose up or down as needed, including adjusting down to zero if the cat is ready.

In general, we try to avoid "canned" posts, but here is the relevant section from my Quick Start Guide:

• The "official" sticky for the protocol recommended on this message board is here
  One of the key links in there is to the chart for the protocol used in a recent peer-reviewed scientific study with great results here.
• Here is a step-by-step guide to starting on the TR protocol: Protocol: Tight Regulation with Lantus or Levemir for Diabetic Cats
• The members of this board will be invaluable in helping you translate this "formula" into what works for your cat. Every Cat Is Different (ECID), so you will need to modify the base protocol at least some of the time.
  • People on this message board will take the time to read and learn everything that you make available, and use that information to give you the best possible advice. In order to help make that easier, there are a few pieces of technology that we use.
  • The Spreadsheet is the most important piece of information you can accumulate for yourself and share to get advice: How to Create Your Own SS and Publish It in Your Signature. Unfortunately, this does not always work smoothly the first time, but once it is setup it is very easy to use. Try this if you are having trouble with the templates, and don't hesitate to ask for help.
  • This link contains a lot of other general message board and Lantus/Levemir protocol information: LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ...
    and this Making the Most of Your Lantus ISG Experience
  • If you get a little lost in our acronyms, try reading this: Are you new and confused about our jargon? Read our Glossary
• The hardest part of the protocol is getting ready and confident to continue treating as your cat gets down into the natural range.
  Just below the natural range is the very dangerous hypoglycemic range.
  Read this post multiple times so that you are prepared on that exciting, but admittedly stressful, day:
  LANTUS & LEVEMIR - SHOOTING & HANDLING LOW NUMBERS
• This post covers proper handling and storage of Lantus and Levemir:
  STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE
• When you are ready to read more, this link is a pretty comprehensive FAQ to answer a lot more questions you will have:
  Frequently Asked Questions List for the Feline Diabetes Message Board (FDMB)

 

Generally the dose is adjusted by the cat's BG levels. The mid-cycle tests determine what the dose should be, which is why it's important to get one every day. I work 10 hour days about an hour away from where I live, so it was impossible for me to get a mid-cycle test in during the day. So what I did instead was test before Bandit's shot in the morning (7am), before his shot at night (7pm), and then 6 hours into the PM cycle (1am). This meant setting an alarm, getting up real quick to test, and going right back to bed. Yes, it's a bit of a pain to do this every night, but the reward is getting your cat safely off insulin and into remission. And Bandit was so worth the minor incovenience. The preshot tests tell you whether or not it's safe to shoot insulin, but that daily mid-cycle test is also vital--it is what determines the dose. I also did a curve (a test every two hours for an entire cycle) once a week on either Sat. or Sun. morning when I was off work to get a bigger picture of what was going on.

Basically what you want to do is gather data right now--each test you get is a piece of that data. The more data you have, the more informed and better your decisions are about dose adjustments. This will give you enough control to keep Spike's BG in a normal range for as much of the day as possible. The longer Spike is in a normal BG range, the more his Pancreas can heal. Once his Pancreas heals, that is when remission occurs.

I really understand how difficult it can be to get enough tests in with a full plate. But once it becomes routine, you really don't mind it. I got to the point with the 1am tests where I was literally doing them in my sleep...thank goodness meters save the test number because my zombie self never cold have recorded the number right.

 

I can probably handle getting up around 1:30 to test if needed!

I just got home and tested Spike's BG and it's 41. His last dose was yesterday AM, although he also hasn't eaten since this morning.The vet did call me back and recommended discontinuing the Lantus. I know that you guys recommend not to go cold turkey, and I was planning on doing it gradually (I haven't had time to read all of those posts that you recommended yet). However, I'm assuming his numbers need to go up more than this for me to give him any Lantus at all.

- Kathleen

 

That is correct, we never shoot 41!

 

Should I be at all worried about his 41? He seems fine.

 

Kathleen,
Did he eat okay at dinnertime? I wouldn't panic about the 41 provided the next test has him a little bit higher. He hasn't had insulin for 36 hours or so?

Carl

 

Sorry, I had to put my little ones to bed.

First, I think you should start a new post, with a new title like "36 hours of Lantus, BG=41, Advice?" You might go ahead and post it in the Lantus forum instead of Health.

I agree with Carl. At 36 hours, there should only be a very small amount of Lantus left in Spike's system, so you don't want to overreact and stress his newly recovered pancreas with lots of sugar.

That said, there is still some Lantus in him, and if he is very insulin sensitive right now, it could be enough to cause a problem. It seems like he may naturally drop to low numbers in the evenings, so a little Lantus might push him over the edge again.

Any chance you picked up some gravy or other HC foods today?

Assuming the answer is no. I would suggest that you feed him some normal LC food, but don't let him stuff himself in case you need to spike Spike with karo in an hours. Test in 30-60 minutes. Lather, rinse, repeat.

So long as he is not symptomatic, at this point off Lantus, I would not start Karo until he was down to 35 or lower, or if any symptoms show up: Read the symptoms here and here

I hope this is really the begining of your OTJ trial (14 days makes it official), but don't count on it. Many cats need to go back on a little insulin after a few days to finish the healing process.BTW, check out S'mores's great video!

I need to go to sleep soon. My littlest is getting ear tubes very early tomorrow :sad:

 

Yep, he ate just fine. I'll test him again in a bit.

Wasn't able to get any HC food today, but will try to get some tomorrow.

Good luck with the ear tubes! I've babysat a lot of kids who got them and they were all SO much happier once they had them!