Newbie.... BG = 69....help! [latest = +8/108]

Gracie's BG at 1:00 PM today when her insulin was due was 218 so I gave the insulin (Lantus, 1/2 unit). At 3:15 BG was 79. Called the CSU urgent care vet, they said give 1 ml Karo so I did. BG at 4:15 was 69. My vet is out of town, nearest open emergency vet is 2 hours away. I reached another local vet who was reluctant to do anything.... she said make sure Gracie eats so I have been feeding her Royal Canin Recovery but she's a picky eater so she's only eaten maybe a tablespoon.

Now what? I have: Royal Canin green pea and duck, Friskies pate, kitten food, kitten milk replacer, Catsure (she likes all of those sometimes.) I'm about to go test again. I of course have Karo and can give more.

 

Are you using a human meter or a pet meter? I think a human meter, if my memory is correct?

 

Human

 

Okay then. Gracie is not in danger. Feed a little low carb food, maybe a teaspoon or two and test in a half hour. Normal is from 50/120 on a human meter. We add some high carbs if she goes down under 50. She is safe.

 

Okay. 69 on a human meter is not as much cause for concern as it is on a pet meter, so that's good. Still, since it's fairly early in the cycle, you want to monitor it and make sure it doesn't start to drop a whole lot further. Anything below 50 is considered hypo territory, on a human meter. When was the last time you checked her BG, and what was it?

 

Not all cats will be hypo in the 40's but that is when you need high carb food and to test every 20 minutes.

 

Last time 4:10PM, it was 69

 

Are you following SLGS? If so she has earned a reduction to .25.

Was that 20 minutes ago?

 

I don't know what time zone you are in so I don't know how long ago 4:10 was for you, sorry. That would be about three hours from shot time, correct? So far Gracie is doing fine. I would check her again in about 20 minutes, as tiffmaxee suggests, and post her numbers then.

 

Thank you, thank you! That's reassuring. I've been reading my cat food cans to find a high carb one. I have one "gastrointestinal high energy" where the fourth ingredient is corn flour. I also have plain pumpkin. Will try some of those.

 

Sorry, mountain time, it's 5:22 here. I will stop typing and go test now.

 

You don't need it yet. See what the next test is. Do you have plenty of strips?

 

Plain pumpkin is great for diarrhea/constipation issues, but I'm not sure it will help much with low BG; the one with corn flour probably will. I wouldn't give anything yet, until you see what her next test says.

 

Much better, 107

 

Yes, just bought the meter and a box of 100 strips last Wednesday.

 

Sorry, don't know what that means.

 

Start low go slow or tight regulation? Is the duck and pea a vet diet food? Wet or dry?

 

So the Karo brought her up. It can wear off quickly. Please test again in 30 minutes, okay? Please put your results in the subject box. Do you know how?

 

She's doing great, then! No need to give any med or hi carb foods, just check her again in about 20-30 minutes, just to make sure she is still rising.

SLGS is Start Low, Go Slow. It is one of the protocols for Lantus users:

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-start-low-go-slow-method-slgs.129446/

If you haven't been there yet, it would probably be a really good idea for you to check out the stickies in the Lantus/Levemir forum:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

 

Should have said -- 107 at 5:32 mountain time, roughly 412-/ hours since her last insulin. And I'm not giving her any more insulin until my vet redoes her bloodwork and UA. I'm beginning to think her high blood glucose was a transitory problem, which has been fixed by lowering her pred and changing her diet. The insulin is causing more problems than it's solving.

 

No, not really sure what that means.....

 

This should say 4-1/2 hours since her last insulin. My computer has a problem, it's so slow it garbles what I type.

 

Never mind, I figured it out

 

Sorry. I got distracted. Would you change it to +4.5/107 please?

 

Cheri, have you tested her again? If so, what was the reading, please?

 

Damn, going down again. 76, 5 hours and 5 minutes after insulin shot (sorry, not good at testing yet..... I usually get an error message from the meter 2 or 3 times before I get a good result, so I'm slow.)

 

Okay, she's still safe at 76. Please check her again in about 15-20 minutes.

 

69, about 5 hours and 20 minutes after insulin

 

Okay. She's still in safe numbers but since her BG is still dropping I would go ahead and feed her a little bit of whatever med- or hi-carb food you have.

 

Please test again in another 15-20 minutes.

 

OK

 

She's doing fine and in safe numbers. She should pass her nadir in another hour or two. These are good healing numbers for her pancreas.

 

82, about 5 hours 20 minutes after insulin

 

82 is good. Was that after feeding?

 

Nice surf going on. What did you feed?

 

Yes.... she eats very frequently, small amounts. I fed her a couple of times.

 

Did you feed her regular food? Max eats often too until nadir.

 

Normally she gets FF classics. This time I offered Royal Canin Recovery and Gastrointestinal High Energy. She ate a little of both.

 

I would keep checking her every 20-30 minutes now, until you have at least two concurrent tests that show rising numbers. I think Gracie will be fine, her numbers are actually quite good!

 

What does "surf" mean?

 

"Surf" means riding a wave of good numbers. Ideally, you want your kitty to surf as long as possible each cycle.

 

Thank you, thank you! The vet said if I got 60, it's an emergency requiring immediate vet care (that was right before they closed up shop for the weekend and left with no one on call). She knew I was using a human meter, we had just gotten through checking my meter. I asked her for some guidance on what to do with the numbers I might get over the weekend and she gave me a sticky note that says "below 90, don't give insulin.... below 60, supplement with Karo and get to vet." But maybe she was talking about pet meter numbers? In any case that wasn't a whole lot of guidance. And I paid $150 for two "diabetes consults"!

 

108, 6-1/2 hours after her insulin

 

I would not feed and test in an hour.

Max has been in the 40's and not ever been hypo, anti-jinx. Now if they drop that low and you can't bring them up with high carbs and Karo that is an emergency.

 

Here's the carb content on what you fed. It appears Recovery is high carb and other

low.http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

 

I don't know where she came up with 60 as an emergency number. We go by 50 on a human meter or 68 on a pet meter.

 

Also, our usual advice to those who are new to feline diabetes is to not shoot if below 200. I'm surprised she told you 90.

 

She's still at 108, 8 hours after shooting, and I didn't feed her anything since before the last test. I need to feed her now though, she's very unhappy with me for starving her. I got an email from her vet at CSU saying change her dose to 1/2 unit, once per day. So no more insulin tonight, which I think is a fine idea. She also asked why did I test 3 hours after her dose? (Which I did just to check how she was doing.) She said don't poke Gracie so much.

 

Under 50 means to give hc or Karo and test every 20 minutes until coming up. And staying up at least in the high 50's -60's. I wouldn't call it an emergency number. I don't think that's what you meant. You wouldn't rush to the ER if your cat drooped under 50, unless there were signs of distress or you couldn't bring her up with food or Karo, right?

 

Once a day dosing is not a good idea. Better to shoot .25 every 12 hours. That's how lantus works best.

 

I can ask her if that's OK. How do you even do a dose that small? I can barely manage 1/2 unit -- I just don't see well enough. My syringes are .3 cc with half-unit markings. Are there better ones available?

 

You are absolutely correct. I did NOT mean that those numbers denoted an emergency, rather a marker for a point of attention to lower numbers. Thanks for catching that and bringing it to my attention so I could make it clear!

 

Do you have a good magnifying glass?

I hope Gracie is doing well and you have an uneventful night!

 

Unfortunately they don't make syringes in quarter unit markings but there is a way. I use calipers. Here's a video to watch that Marje made on how the use them. Until you get them you could make a paper one. Lantus doesn't usually work for more than 12 hours.

http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

Also in addition to a magnifying glass you can wear two pair of reading glasses on top of each other.

 

Thanks..... I will figure it out.

Just got another email from the vet at CSU. She pointed out that Gracie often has odd reactions to medications -- she over-reacts to stuff. So the rules for cats in general may not apply to Gracie. It could be it's a Cornish Rex thing. When I was learning how to test, the vet told me practice on my other cats and I got BG of 52 and 53 on my other two rexes. These are healthy cats (except for IBD and heart disease, like Gracie) who eat high carb dry food. Interesting that their "normal" is down at the bottom of the scale.

 

That could be a possibility. Obviously she knows Gracie well. I would ask her about the once a day vs twice a day dosing, though. As tifmaxee said, Lantus is usually given on a 12-hr schedule. It doesn't really last more than 12 hours.

As far as her saying you're poking Gracie too much - I don't know why some vets are so resistant to clients home testing their cats, but we see it a lot. The only way to ensure the safety of your cat is to home test!

 

My vet at one point was going to have me give different doses morning and night because he thought it would be too hard to make .25 changes. I explained how I could do it using calipers. Problem solved.

 

A little heads-up for the future re pumpkin. Although plain pumpkin contains carbs it is primarily a source of fibre and can have a lowering effect on BG numbers, so it's not a sutiable 'tool' for steering a cat through low numbers.


Mogs
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A useful optical tool to help with measuring doses is a jeweller's loupe.






Try Ebay for a cheap 'n' cheerful one.


Mogs
.

 

Thanks again everyone for lots of helpful ideas! At 1:00 PM today after 24 hours without insulin, Gracie's BG was 118. That was after eating fairly normally (for her) all morning. She was due for her next shot but I didn't give it. Our local vet is back in town and when I updated her about Gracie's weekend, she said continue to test daily but don't give insulin unless I get two consecutive BG's over 200-250, or one over 300. (She waffled a bit about the lower number -- first said 200, then 250). I also asked the CSU vet for her opinion, haven't heard back.

 

Thank you for the update! I hope Gracie's BG continues to stay in good numbers!