Not responding to insulin, and so tiny I might lose her

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Charlotte + Dino Baby, Jan 10, 2020.

  1. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

    Joined:
    Dec 29, 2019
    Hello! Forgive the scatterbrained post, I have little time but am hoping to get a little help so I don’t have to resort to putting the love of my life down :(

    My cat has always been quite slim, even though she has a long frame she’s never weighed more than 7.4lbs or so. Due to diabetes her weight is now down to 5.5lbs and I’m so scared I’ll lose her!

    She was diagnosed around 2 weeks ago but thus far has not been responding to the insulin. Vet said to give her one unit of Lantus once a day in the morning. That seemed odd to me, but I did it for 4 days. Her blood sugar remained in the high 300s, so I increased to 1 unit twice a day. Her blood sugar still remains around 320-350 (on a human monitor).

    She of course continues to lose weight, peeing constantly, and today has developed diarrhea. Today I said F it and just jumped her to 2 units because if this doesn’t get under control ASAP I’ll probably have to put her down. She’s so small there’s just no room for error! Over the last 48 hours her appetite has decreased, she seems weaker.

    My biggest fear is that none of the insulin is actually making its way into her system. I’ve watched dozens of videos, but none of them are dealing with a cat who is literally skin and bones. It’s so hard to inject, her skin is incredibly thin and she has no subcutaneous fat. After injecting her, even times when I do feel quite confident I’ve gotten it below the skin but not into muscle, she still smells of insulin after.

    Any and all recommendations are deeply appreciated! My girl and I thank you all for everything you do!
     
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  2. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hi Charlotte and Dino baby and welcome to you both.
    just a few questions if you don’t mind to help you.
    is she eating the food ok? I see you are giving her low carb which is good. If she is very thin Hills have a recovery food called A/D which is very good.

    Are you home testing the blood sugars?
    This is one of the most important things you can do. We can help you with this. You mention a human meter so hopefully you are testing.

    It is not advisable to double the dose from 1 unit to 2 units especially if you are not testing the blood sugars. We recommend increasing the dose in 1/4 unit increments.
    Are you using a insulin pen or a syringe to inject the insulin?

    Did the vet mention ketones at diagnosis?

    You can try giving mashed pumpkin for the diarrhoea. A teaspoon twice a day. Plain mashed pumpkin with nothing added.

    If you can smell the insulin,it may not be going in. Please never try and give a second dose if this happens. It is too dangerous.
    are you making a tent when you give the insulin?

    I am sure we can help you. Diabetic cats often lose weight in the beginning. My cat Sheba was quite thin but she put it all back on and more.

    Please give us as much information as possible.
    Bron
     
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  3. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    Welcome Charlotte and Dino Baby! Please do not despair just yet! I was in a similar place as you when I joined this board. My girl was suffering from multiple chronic conditions and I spent months and months trying to get her diabetes under control with no success, but with the help of the board she is now happy and healthy.

    I will caution that diabetes is rarely an ASAP process - it really is a slow and steady process in most cases. I know when our babies aren’t feeling well we want them better right now, but it really does take patience. My cat was also skin and bones when she was first diagnosed and it took her a few months to gain weight back, but she did gain it back. Is there a reason she’s on the Stella and Chewys rabbit? Just personal preference or does she have food allergies/intolerances? Do you know the fat content? Getting her blood glucose under control will help her gain weight, but I’m wondering if a food with more fat/calories in the meantime would also help. The A/D Bron recommended is great, but if it’s not an option because of allergies, Instinct has some limited ingredient diets that are fairly high in fat (lamb and rabbit are two options)
     
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  4. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

    Joined:
    Dec 29, 2019
    Yes, testing sugar at home daily, that’s how I know her readings are still around 350 (diagnosed she was at 422).

    I have a Lantus pen and use the pen needles. I am making a tent, but she’s long haired and it’s just SO hard to tell if it’s going into the right spot because she has no fat and her skin is so thin. Thinking of shaving a spot or two on her flanks.

    No ketones at diagnoses 3 weeks ago.

    Shes still eating okay, and drinking lots of water. I actually chose the Stella and Chewy’s rabbit for it’s higher fat content (min 10.5%) and because it was the lowest carb I could find. I will check out the A/D! It’s been years since she’s had any of the additives Hill’s puts into their food, so I had been hesitant to switch her over to it when the vet mentioned it because I wasn’t sure how her body would react. Before diagnosed she had been eating Ziwi Peak, so still very low carb but I didn’t like that it had chickpeas in it.
     
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  5. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Dec 3, 2016
    Charlotte, it's exactly how Sarah described it. The secret to diabetes is that there is no secret, no magic food or some exact dose that you're missing. It's a slow and steady thing and it's never the same for any two cats. I've been there twice so I and a thousand other people here all know what you're feeling right now.
    At Dino Baby's age and weight there's probably something else going on, it will not be diabetes that takes her from you. Keep posting and know you're both in the best place possible right now. That's all I have for you right now, it's not medical advice but you need to know people care.
     
  6. Lisa and Witn (GA)

    Lisa and Witn (GA) Well-Known Member

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    Dec 28, 2009
    Are you testing before the shots or sometime between?
     
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  7. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    With long haired kitties it can be hard to tell if you got the insulin in or not. My cat was long haired, and I took a pair of blunt tipped scissors and trimmed the fur as close as possible and then used a safety razor and lightly shaved a 2" by 2" patch on his side until I saw skin. I also shaved a little patch on the outer edge of his ear, because with the black fur, it was hard to see the blood drop forming for testing.

    You said you were trying to shoot into the muscle, but you should be trying to get the insulin in the fat layer under the skin, not into muscle.
     
    Last edited: Jan 12, 2020
    Charlotte + Dino Baby likes this.
  8. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Most of us using Lantus use syringes to inject. It might give a bit more control over the injection. You will eventually need syringes anyway, as we make dose changes by small amounts. The syringes with 1/2 unit markings allow you to make changes by as small as 0.25 units at a time.

    Part way down this post on Testing and Shooting Tips are some pictures and a video that may help.
     
  9. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

    Joined:
    Dec 29, 2019
    Does one milligram once a day sound - as the vet prescribed - sound like the correct dose?

    Sorry if I was unclear, I’m aiming to administer subcutaneously (not into muscle).
     
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  10. Jennifer R.

    Jennifer R. Member

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    Dec 20, 2019
    Lantus is typically given once every 12 hours, equaling twice per day, but some times vets advise once per day. Have you read up on Lantus and how it works?
     
    Last edited: Jan 11, 2020
  11. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Do you mean I unit of insulin once a day?
     
  12. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

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    Dec 29, 2019
    One unit, yes! My mistake.

    Today and yesterday she has gotten 2 units twice a day. Is it safe to keep her at two units twice a day as long as I’m testing blood sugar daily? This morning she was 390 fasting and 340 two hours after her 2 units.

    Can anyone tell me how long it took to get their cat’s blood sugar below 200 or what that process was like?

    Also, is the general consensus that I should put her on Hill’s a/d to help her gain some weight or is the increased carbohydrates only going to worsen her diabetes? Her current food is extremely low, around 2%.

    Again, thank you all. I was in such despair last night but am trying to feel a little more optimistic thanks to your kindness!
     
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  13. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    It is quite safe to give her some a/d to help her put on weight.
    It is very hard to help you with dosing if you don't have a spreadsheet with data on it.
    Do you think you could set up a SS and put in the numbers so we can see what is happening?
    Here is the SS link. If you have any trouble tag @Chris & China (GA) and she will help you with it.

    http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    How much insulin did the vet prescribe.?
    2 units twice a day in a newly diagnosed small cat is a lot of insulin.
    Are you testing before EVERYshot to see it is safe to give the insulin?
    Are you testing during the cycle (somewhere between +3 to +7) to see how low the insulin is taking Dino Baby?

    It would be a good idea of you could swap over to giving the insulin via a syringe and not the pen as you can give smaller increases.
    We can help you with the correct syringes.
     
  14. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    I've already set one up for her. She just isn't using it yet so there's no data to share
     
  15. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Thanks Chris.
     
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  16. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Charlotte, Chris has said she has set up a SS for you.
    Could you enter any data ( numbers) you have please so that we can help you.
    We are unable to help with just a few numbers put into a post. We need to see them all in a SS.
    Thanks :)
     
    Charlotte + Dino Baby likes this.
  17. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    There is no link to the SS in Charlotte's signature. Could you help her with that please @Chris & China (GA) ?
     
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  18. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

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    Dec 29, 2019
    I haven’t started the spreadsheet just yet as I’ve been working insane hours! I work in Hollywood so I don’t have a normal schedule. My husband has been helping me with Dino Baby. I will start the spreadsheet on Monday when I have a day off. I just haven’t had the tine to figure out how it works. I’ll add the link in signature then! Thanks again for that Chris.

    I’ll buy the syringes Monday as well. Which are best?

    We've been taking her BG before each shot, and when I can I’ll do a mid cycle as well. The lowest reading she’s ever had was 340 two hours after 2 units. All other reading have been between 360-400.

    I had no idea 2 units was a lot! I will switch her back down to 1 unit twice a day until I get the syringes. The vet prescribed 1 unit once a day, but said if I’m testing her BG at home I could advance to 1 unit twice a day. I wish she would have given me some frame of reference for how long it would take for her numbers to improve! I had no clue she would be on it for weeks with no real shift in numbers. Thank god you guys are here!

    I’ll get some cans of Hills A/D Monday as well and alternate with her rabbit which she just loves.
     
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  19. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Welcome!

    I want to back things up a bit and do a bit of educating that may help to ease some of your concerns.

    First, it would be fairly unusual to see a response to Lantus during the first week of treatment. Lantus is a depot type of insulin. The depot is like a storage well. It takes about a week for the depot to form and stabilize. Since a small amount of the insulin you are injecting is deposted in a microcrystalline form into the fat tissue, until the depot is in place, you may not see much change. Likewise, when you change a dose, it takes up to 3 days/6 cycles for the depot to catch up with the change.

    Lantus dosing is based on the nadir -- the lowest number in the cycle -- and not on the pre-shot numbers. If you are worried that numbers early in the cycle are high, it will help (and is actually very important) that you get some spot checks somewhere toward the middle of the cycle. Most cats' nadir is somewhere in the vicinity of +6 however, that's not true for all cats. My kitty's nadir was early, at around +3. In addition, nadirs can and do shift around. (Why would our cats want to be predictable?) Again, it's expected that the pre-shot numbers would be higher since the insulin has begun to wear off. The +2 number (the reading that's 2 hours after you've given a shot) is also a number that is likely influenced by food so it may be artificially high. Lantus onset (when the insulin starts to work) doesn't occur until around +2 for most cats.

    Hopefully, you're breathing a bit easier. If you've not one so already, you may want to take a look at the sticky notes at the top of the Lantus board. There's a wealth of information in those posts that will help you to understand how Lantus works. Frankly, it's different than most other types of insulin that do not have a depot. The big trade off is that Lantus is gentle and has a long duration which is good for cats since they have a fast metabolism.

    At this point, it's also fine to give your kitty some extra food. I wouldn't worry about over feeding right now. As long as the food is low carb, feel free to give multiple small meals.
     
  20. Niutek

    Niutek Member

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    Nov 22, 2018
     
  21. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    You want 3/10ml, 31 gauge insulin syringes with half unit markings.

    All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
    UltiCare
    Monoject
    Carepoint
    Sure Comfort
    B/D

    They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)

    Relion syringes.jpg
     
  22. Jennifer R.

    Jennifer R. Member

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    Dec 20, 2019
    FYI, I don't know if this will help you or someone else, but if you have an Android phone or an iPhone, you can install Google Drive and Google Sheets on your phone and you can actually update the spreadsheet from there, if you're not home. Instructions here:
    https://support.google.com/drive/answer/2424384?co=GENIE.Platform=iOS&hl=e

    Have you talked to the vet about the diarrhea?
     
    Last edited: Jan 12, 2020
    Reason for edit: Clarification
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  23. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    How are you and Dino Baby doing Charlotte?
     
  24. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

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    Dec 29, 2019
    We’re good thanks to you all!

    The morning after we gave her 2 units twice a day her fasting blood sugar was 93. I was so shocked I took it twice to be sure. I wasn’t sure how to interpret this dramatic drop, and didn’t have time to consult this board, so we moved her back to one unit twice a day until I could post here. Now her numbers are back up in the high 300s. I will fill in her spreadsheet today with what we have!

    The great news is we have no trouble taking her BG and she doesn’t seem to mind that or her shot in the slightest. Her ears are still looking a little worse for wear though, but I’ve started applying a small amount of neosporin so hopefully that helps!

    My husband has gotten really good at administering the insulin while I’ve been working, so he’s going to help me learn his tricks.

    Her diarrhea only seems to have lasted that one day, not sure what caused it! I’ve never seen her have diarrhea in 14 years. Never thought I’d be one of those people sifting through a litter box with a microscope but here I am, lol. She’s still peeing a lot though, which does scare me.

    Chris thank you so much for the syringe recommendation! Her vet had no input (another red flag) so I really appreciate it. She also denied my request to fill an order for Hills A/D because she said it was extremely high in carbs, and didn’t believe me when I said I had researched it and that Hills own website states 13.2% which is actually lower than W/D. She said I must be confused and that she’s going to discuss it with the clinic’s Hills rep and get back to me tomorrow. Unsure why she couldn’t just check the numbers on their website? Anyway, if anyone has a food to suggest that is comparable and doesn’t require a prescription please let me know!

    Sienna thank you for that, so useful! I will dive into the Lantus board ASAP. And Deb, thanks for checking on us <3

    I don’t want you guys to think I’m an irresponsible pet owner, I just work a very odd schedule (for instance I’ve been out of the house from 6am to around 10pm for the last 5 days) so when I’m here I have little time to do anything besides sleep and shower. In my line of work there isn’t any time spent near a computer and I usually eat on the run. I sometimes miss the days of sitting at a desk all day! Luckily my husband has been extremely helpful and positive about this whole ordeal! Once I know how to use the spreadsheet it will be easy to plug numbers in on the go and share the doc w/ my husband so he can do the same.
     
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  25. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Dec 3, 2016
    An irresponsible pet owner? Charlotte, you just got whacked with a diagnosis you never expected and no one expects you to get another job because of it. I see that everyday you're getting and using the boatloads of info we're sending you. You have no idea how many people just give up as I was told to or come here and just never come back. Guilt and shame is not what we do here. This will all take time, it did for all of us.
     
  26. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Charlotte -

    You have lots and lots of options for food. This is a link to a food chart on Lisa Pierson, DVM's website that's devoted to feline nutrition. The chart list carbohydrates and calories (along with other nutrition information). There are a great deal of low carb options. If you were using the A/D as a means of adding calories, just look for low carb, high calories or, if Dino Baby's appetite is good, just feed him more!

    If you are looking for novel proteins, such as rabbit, I really like the ZiwiPeal line of canned food. It has no gums or carrageenan which can be problematic for many cats. They also have an air dried raw diet line of food that my guys like.
     
  27. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

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    Dec 29, 2019
    The spreadsheet is up and running! Wow what a relief to finally have time to tackle this. Spent some time learning the SLGS method today and plan to follow that as closely as possible from here on out.

    I've purchased the syringes Chris recommended and have bumped her dose up to 1.25 units starting this morning. Will hold here for a week and see what happens!

    Her vet offered Hills M/D GlucoSupport but would not approve A/D. I've decided to just feed her more of her current food at mealtimes, which is higher calorie and lower carb than either A/D or M/D. I will portion according to target weight rather than current weight.

    Hope to see a reduction in thirst and urination this week!

    Much love from the girl and I! :cat:
     
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  28. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

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    Dec 29, 2019
    She ate Ziwi Peak exclusively in 2019 and during the onset of her diabetes, so we've sworn it off out of superstition! I'm sure I'm probably being silly, but I thought maybe there was some bizarre connection to the chickpeas or green lipped mussels since those were all new additions to her diet in 2019. The food chart is incredibly helpful though, thank you so much! What a wealth of info.
     
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  29. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

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    Dec 29, 2019
    Quick question! What is the order of operations and timing for testing/mealtime/shot? Is the pre-shot number taken immediately before giving the meal? I typically test (PS), set out food, and give insulin towards the end of her meal while she’s still eating. Is that correct? I’ve been looking everywhere for the answer!
     
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  30. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Test/Feed/Shoot is correct for Lantus insulin All within about a 15 minute window of time.
     
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  31. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

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    Dec 29, 2019
    Thank you Deb!!!

    Doing a little home BG curve today and at +9 she is sitting at 102. I was presuming she would have been lowest at +6, but she had just had half a packet of Tiki Cat Velvet so maybe that raised it a bit?

    Today was my first day using a syringe (instead of the Lantus pen needles) and it makes me wonder the dose was a little fatter than I intended, or perhaps that not all of the insulin had been getting in previously with the needles. Whereas I was always a little unsure if the pen had “worked” the syringe made it much easier to see what I was doing and there was no question that the full dose was administered. Either way, she is more content and affectionate than I’ve seen her in a long time and I’ve only seen her use the litter box once today.

    thanks for the quick reply!
     
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  32. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Please remember this is a marathon not a sprint. It was almost three months before I even saw a number under 300 for my cat.

    You guys are Doing awesome and I'm so glad you're home testing.
     
  33. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

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    Dec 29, 2019
    Yesterday I did my first at home curve. Please see our spreadsheet! Her nadir was +12 after her morning shot. So I skipped insulin last night and just fed her instead. This morning her meter read “Hi” which means over 600. One hell of a bounce!!!

    She is *very* small and her food has 1% carbs; is it possible that the insulin really did take that long to be metabolized? I’m so confused by this!
     
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  34. Kek

    Kek New Member

    Joined:
    Oct 12, 2019
    Sounds quite similar to the issues I was having with my cat. Nadir was often coming at 12+ hours. I'm not as experienced as the other people on this forum, but I was told by my vet if the preshot BG is too low to feel comfortable shooting at, give half the normal dose, but do not skip a dose. Lantus is a slow acting insulin so if you skip the dose you will see those numbers rise much too high again. The more/closer you can keep your dose consistent the better you will be able to see the true result of the insulin as the body gets use to it over 2-3 days.
     
  35. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Charlotte absolutely did the right thing last night, skipping the shot. She is gaining experience here, but does not know everything yet.

    Charlotte is new, 2 weeks into this journey with diabetes. Only 1 week posting on here.

    DO NOT DOSE Lantus insulin if AMPS or PMPS is <150 and you are new at this. Some people use pet specific meters, and the shoot/no shoot numbers are different. Different shoot/no shoot number for other insulins.

    Please look at Dino Baby's SS. Linked in the signature. To familiarize yourself with the situation, you could read her other posts too. She is posting over in the lantus forum right now.

    Just changed the food too, right Charlotte?

    We do not want a cat to hypo, have possible convulsions or coma and emergency visit to vet required.
     
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  36. Charlotte + Dino Baby

    Charlotte + Dino Baby Member

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    Dec 29, 2019
    Deb is right, we’re still learning! She has been on the Stella and Chewy’s food for a few weeks now. I’m glad I knew from everyone here to always check BG before shooting and not to shoot a number that low. However, her being off the charts this morning really scared me! Nice to see a clear response to insulin though.
     
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  37. Ann & Scatcats

    Ann & Scatcats Well-Known Member

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    Dec 31, 2009
    Hiya


    I LOVE her Dino Baby name :bighug:. A name for a Heroe :cat:


    I hope we collectively can get her sorted.


    My female Tjejen (which means Chick) was a Quarter Persian and as such, Persian, she only wanted to eat Sheba :cat:

    They are very particular with their foods what they like.
     
  38. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Kek gave you some dangerous advice. Please don't follow it.
     
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  39. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Dec 3, 2016
    "if the preshot BG is too low to feel comfortable shooting at, give half the normal dose, but do not skip a dose"
    That's not right Charlotte even if a vet said it. Feline Diabetes is not taught very well at most veterinary colleges. We all want to establish a sense of routine with our cats but that does not mean intentionally missing a shot is a bad thing.
     
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  40. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Charlotte and Dino Baby are over in the Lantus forum now. Graduated yesterday. Good thing, since Dino Baby had low numbers last night and her 911 call for help got some experienced eyes to help out with that.
     
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  41. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feb 28, 2012
    A little clarification on whether you give insulin if you get a number lower than you are used to. There is no one answer that fits all situations. How new the caregiver is, whether they can monitor during the cycle are two factors. Probably the most important factor is whether kitty has recently been diagnosed with DKA or has been showing ketones. In that case, at least some insulin is important. Our suggestion, should you see those lower numbers, is to not feed, and post here for help making the decision.
     
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