numbers are down!! please help

Hi guys,

Not sure what to do now. Gave Shimi 1 tea spoon of sugar water is that enough? please check my chart.
When should I test again? He is eating and doesn't look like coma is next. but I checked twice, just to make sure I wasn't seeing a false reading. can someone please tell me what to do next? This is a first time his sugar is so low.

 

First breathe. It's a good idea to post the number in your subject line. Are you using a human or pet meter? If you got a 68 at +8 that isn't too low on a human depending on which protocol you are on and which insulin. This is my first time with you so can you fill me in a little?

 

@tiffmaxee hi and thank you for checking in. I'm not yet familiar with how everything works around here. Thank you for the advice.
Using a One Touch human meter. He is getting 4.5 units of Lantus twice a day. Shimi always had high numbers. This is a first dive. I gave him 1 tea spoon of sugar water and some wet food. not sure whats next...I'll recheck in an hour?

 

Every 30 minutes you can check his glucose until you are sure it is rising and in safe numbers.
If he drops below 50 mg/dL on a human meter, you may give 1-2 teaspoons of high carb gravy or a few drops of syrup, wait another 30 minutes or so and re-test.

 

@BJM, Merci! I'll post his numbers at 4 pm my time.

 

This post will give you some guidelines for managing low numbers. A 68 isn't low to the point of panicking but since you're new to this, we all understand the nail-biting reaction! Basically, give some food and re-test in 20 min.

Please do whatever you can to get a test before every shot. Also, it's very important to get at least one test during the PM cycle. Many cats experience lower numbers at night. In addition, if you don't test during the PM cycle, you're missing half of your data and it makes it very difficult to provide any guidance since we're all guessing at what's going on with your cat.

 

Okay. You can steer with food and its toward the end of the cycle. He would ear a reduction if he drops under 50. Just to let you know that while scary to see lower numbers but not a a danger point, Max dropped to 42 the other day.

Test again 30 minutes after you fed him and post the results.

 

I have to pop out to help a local friend. You're in good hands here.

And breathe! You're doing great!

 

I'd also read the SLGS and TR protocols to see which way yiunwant to go. If you can't test much the SLGS might work better for you. If choosing that your cat earns a reduction the next cycle as that one reduces with a 90.

 

@Sienne and Gabby @tiffmaxee Thank you so much. Printed low numbers protocol... posted in Shimi's bathroom. I'll update his chart in 20 minutes with new numbers.
I will most definitely test again all the way up until PMPS. should I give him only 4 units today? or is it something I can determine based on his PMPS numbers?

 

@tiffmaxee whats SLGS please?

 

You will determine the dose at PMPS. I would see if the numbers are trending up and post asking for dosing advice. Use the question mark before the subject and add the number to your title. What was the last BG?

 

We crossed posted. The two protocols are Tight Regulation and Start Slow Go Slow. TR is more aggressive.

http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/

 

Sorry for all the questions but who has been advising you as to the dose you are giving? You seem to be raising the insulin too quickly but maybe there's a reason. When was the diagnosis?

 

very last was close to an hour ago 64. going to check again in 5 minutes and will post his new numbers.

My vet, then another...they diagnosed Shimmi on June 5th with Type 2 Diabetes, and started him at 3 units....he was like that for 3 weeks. Then I took him to the vet because he started drinking a lot again and peeing a lot and the vet increased the dose to 5 units., I couldn't deal with 5 units, so I asked another vet he said 4 units. Then Shimi's sugar sky rocketed and I decided on 4.5. please take a look at his spread sheet. Everyone here already told me its too much....but I'm really afraid to lower the dose without any kind of stable (more or less) sugar levels. Just checked him again, BG is rising 138 Thank God!

 

The thing is lantus takes time to build up a depot. Too much insulin can look like no enough. You could miss the best dose by increasing too fast. That is why it is advised not to increase more often tha every 3-5 days. It is dosed based on the nadir, the lowest point in the cycle. That can be anywhere from +5-+7 usually but can occur right before the next shot too. Max us 16 pounds and was started in one unit and my vet had me increase no sooner than every 10 days. He wasn't started on a high enough dose for his weight and taken off insulin too soon. Then I had to restart. The people who give dosing advice here are really good at it. Trust them. That's my two cents. Remember normal numbers on s human meter are 50-120.

I have to leave now.

 

@Tals, how is he doing now?

 

He might bounce and go much higher by PMPS since he's not used to normal numbers.

 

Hi Rhonda,
He is lethargic...looks like he is resting. I'm 2 hours away from his PMPS. I think if he is in high-normal range, I"ll give him 4 units. if he is low still, 3.75 or 3.5. in any case he is getting less insulin tonight.

 

@tiffmaxee do you think its a good idea to lower a little his insulin?

 

His nadir today was good. He might drop again tonight but he also could bounce and go high. I think his insulin has been increased much too fast but I'm not sure how to fix this. I'm going to see if I can find your older condos. BRB

 

You need to remember that after hitting such low numbers earlier ( that je is not used to) there is a good chance that he will bounce up into higher numbers. You need to base your dosing on his nadir (lowest number of the cycle) not on his pre-shot number when using either Lantus or Levemir. I am not experienced enough to offer dosing advise but if you add a ?? to your title I am sure more experienced members can give you some help.

 

this is the first time posting in Lantus forum. I was talking to folks here in general forum before, under the heading looking for some advice

 

I looked at Tuxie's chart I hope his sugar balances out today.

 

Hello in this forum Tals. Is Shimi completely off of dry food now? That's probably why you are seeing the lower numbers today. I think I would definitely lower his dose. Maybe to 4.0 units. Once the dry food is out of their system, it can make quite a difference.

For future reference, if you see a number below 50 (2.8) is when you need to add high carbs. If you don't have a high carb cat food, you an add a DROP of honey or syrup to his regular food.

 

Okay I read your first post and saw that Marje advised the 4.5. I would post about 20 minutes for dosing advice. Do you have lots of test strip and high carb food/ gravy and can you stay up for at least 7 hours after you shoot? If he is still rising shooting the 4.5 would probably be the thing to do since he didn't drop under 50. If you can't stay up then a reduced dose. Ask for dosing advice and put the nadir and PMPS number I your title.

 

Good Wendy is here to advise you.

 

@Wendy&Neko Hi! Thanks for checking in. No dry food for few days already. I just posted for dose advice as well. So it may be safe to reduce to 4? That's great.
I can totally stay up... why should I stay up? I mean what can happen over night? or what am I looking for and how soon after his evening meal should I start checking his sugar again? Sorry for so many questions.

 

When you get your PM blood test, can you post it here before feeding and shooting, for dosing advice.

I don't know how long it's been since you fed the sugar to Shimi, but sugar can wear off. It would be good to get a test two hours later to see if he's dropping back down or not.

 

Some cats, such as the black and white kitties named Neko and Max, drop a lot lower at night than during the day. That's why we suggest getting a test before you go to bed. We determine the Lantus dose by the nadir or low point, and you may be more likely to see those lows at night.

 

It's good to get a +1 and +2 to see what might happen overnight. Just like you got the 68 today you can get a number that low or lower tonight.

 

@Wendy&Neko @tiffmaxee his sugar is going up...335 right now. he should get a shot in an hour. am I going down to 4 or keeping it at 4.5? what do you think guys?

 

He is bouncing like I mentioned earlier as a distinct possibility. Since it is likely that he is getting too much insulin and not eating dry food any more, if he were my cat I would drop his dose to 4.0 units. I bet that will turn out to be too much soon. I hope Wendy and others will give you their opinion. Remember the dose is based on the low point and not the preshots.

 

@tiffmaxee he is bouncing. You were right! I want to lower his dose badly...ok I'll give him 4 and will check his BG +5 & +7 (I'll set an alarm) just in case will have the syrup ready and a high crab wet food. second time around shouldn't be as scary as it was today. There is about 30 feet between Shimmi's bathroom and the kitchen... today I learned I can fly. Sugar water was everywhere though...Thanks for everything, truly.

 

Please get a +2 as the old dose may be in play here. We have no idea how long the bounce will last. Post that number and then we will see what other tests need to be done.

 

A bounce happens when the glucose drops suddenly and/or drops to an unfamiliar level.
Compensatory hormones release stored glucose (glycogen) into the blood stream to raise the glucose back up to a safe, or at least more usual number.
The elevated levels may take up to 3 days to clear.
With Lantus, the built up depot (accumulated residual from shots) may continue affecting future glucose levels for 3-5 days.

Have you figured out which protocol - Tight Regulation or Start Low, Go Slow - that you would like to follow?

 

@BJM what do you think? Tight regulation requires checking his BG 5 times a day. I dont' think I can do that... I mean I can, but I'm having a very hard time with it. Other than that I would probably chose Tight...given it was tested and proven. What would you suggest. I can check his blood 2-3 times a day..maybe 4? not even sure...for how will I have to do that? forever? then maybe SLGS is better...but my cat is already on such a high dose, the first part of the protocol is out the window with my units. What do you think BJM? What would you do?

 

I'm not sure why you're lowering Shimi's dose other than you're being apprehensive. Since you've lowered the dose to 4.0u, I want to make a couple of suggestions -- well, recommendations with some oomph behind them.

• please start testing for ketones. Shimi is recently recovering from DKA. Get Ketostix at any pharmacy and start stalking your cat to the litter box to get a ketone test. This is a small investment in monitoring that can save you a fortune in vet bill to say nothing of keeping your kitty safe. One of the big ingredients that leads to ketones developing is not enough insulin.
• Start testing at night. A before bed test is essential. Again, testing is the best way to keep your cat safe.
• If you are nervous about numbers dropping too low, test more. With Lantus, if your +2 or +3 test is considerably lower than your pre-shot test number, there's a good chance that numbers will continue to drop. Getting an early test and then another couple of tests will help you to understand your cat's patterns.

At this stage of the sugar dance, it's important for you to begin to collect enough test data to understand when Lantus onset begins and where nadir falls as well as how much duration your getting. While 4 tests per day is the minimum, this level of testing will not give you the big picture of how Lantus is working for your cat.

 

Nice to see a breakthrough here testing will get easier as you both get used to it, most kitties end up wanting their tests so they can get the treat, my mums cat runs to his testing spot as soon as he hears the phone alarm now you don't have to decide right now but I would highly recommend you try TR, some kitties don't need to be on it for too long once their diet has been adjusted and it is your best chance of remission.

 

Choosing whether to go Tight Regulation or SLGS is very much a personal decision, based on your circumstances. If you go with one for now, you can always switch to the other later if you want. If kitty is on dry food, they must go SLGS, otherwise it's up to you. The main differences are the blood glucose values at which the cat earns a reduction, and how long you hold a dose.

At this point it's hard to say how long you will have to keep doing the testing. Some cats have the ability to go into remission, and the faster a cat gets regulated after diagnosis, the higher the chance of doing that. Some cats have secondary conditions that make regulation (and thus remission) harder. Testing will get easier. Trust me, we all had difficulties at the beginning.

 

@Sienne and Gabby , I shouldn't have lowered? oh my what to do now? its too late...I already gave him a shot. in 45 minutes or so it will be his +2 @Wendy&Neko wants to see this number (thanks for the hug Wendy, right back at you) Basically I hear you, people. poking Shimi's ears must be classically conditioned to a treat. its the blood the freaks me out more than anything...and then the bruising on his transparent earsies I guess I'll go with TG for now because you are absolutely right, I need to learn how the insulin is acting inside Shimmi
Of the topic, I switched his food to high protein and he stopped going #2s...I haven't seen anything in more than 24 hour. but the HC food he got today when I panicked might help a bit...

 

If you decide to follow SLGS, he would earn a reduction today by going below 90 mg/dL.
For TR, you would continue with the dose, and get checks in the +5 to +7 time period whenever possible to monitor the lowest glucose. If he goes below 50 mg/dL he would earn a reduction. If you go with this, vary the times in the period +5 one day ,+6 another, +7, +5.5, etc. as the nadir can and does vary. And if you can bear to do it, set an alarm and test overnight as cats may go lower at night.
I'm a wimp and away from home too much to be comfortable doing Tight Regulation; I used ProZinc for Gracie, my most recent diabetic.

Sudden food changes can provoke sudden GI changes. And of course, much dry food has inert fiber added to it in order to give it a shape (cats don't need that much fiber!). Pop over to Feline Constipation and do a spot of reading to understand more

 

@tiffmaxee his +2 right now is 477 oh god
I'll take another reading in the middle of the night and will post it of course. Thank you everyone for your help! hopefully everyone's kittie has a good night sleep without spikes or dives.

 

Since he's bouncing I wouldn't get up in the middle of the night but that's up to you. The more data you have the better. With a PMPS that high I doubt he will drop real low.

 

I knew you would get different opinions on how much or whether to lower the dose. Wendy suggested you lower it and since you took him up so fast and stopped feeding dry food I felt that was a good idea. Sienne feels differently I guess. The good thing about this is once the bounce clears if he is too high you can go back up. Another good thing is often you will get different opinions on how to handle FD. I read and then go with my gut.

More reading for you. Read the stickie on can I do TR and work full time.

http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/

 

He is bouncing. See the second post here for an explanation. He's not used to the lower number he got today. It's a normal blood glucose number, but his body is used to higher numbers.

With Lantus, we like the +2 test, because it can often be a heads up as to what the cycle will look like. If it's about the same as the preshot number, it'll be a normal Lantus cycle with a downward curve. (See the New to the Group Sticky for a description). If the number is significantly lower than the preshot, you'll have an active cycle and those are the nights you want to get up and test the mid point. If the +2 test is higher, then it's likely a bounce or quiet cycle, and you can get your sleep. You could get a test before bed tonight if you want to gather the data, but it should be a quiet night.

As for the decrease, I wasn't sure if you still had dry food in the picture, and the number today would be a decrease according to SLGS. Not to worry, just get some ketostix and make sure you test for ketones when you can. I once stayed with someone whose kitty went from 5.5 units of Levemir to zero in one and a half days, once she removed dry food from the house, so I tend to be more conservative when kitties are on a slightly higher dose and removing dry food. But Sienne is right, with kitties and a history of DKA, you need to make sure you don't decrease too much.

 

Also, we adjust doses by 0.25 units at a time unless the nadir was pretty high. This is eyeballed for 0.25 or 0.75 unit marks.

 

Hi Tals! Glad you made it over here!

I think since you've gone to 4.0 tonight, I'd stay there and try to get more tests in so you can have some confidence in what this dose can do. When you see green numbers again, think of it as "YIPPEE HE'S MAKING PROGRESS!" Those green numbers are normal for a non-diabetic cat, and to protect their body the sooner a diabetic cat gets back into normal numbers, the better. High blood sugar is damaging to a cat's body.

What Sienne is saying is that there isn't anything to say this dose is too high for Shimi, although with the Start Low Go Slow method, you would reduce when he goes under 90. The thing is, I'm not sure you can jump in at 5u or so and then decide to follow SLGS. I would second her suggestions to please test twice a day or so for ketones and get at least one before-bed test in. Those are really important.

It's a confusing situation, but we can help you work through it. A little more info (ie, tests) will help us help you figure out how to move ahead.

You may need to go back up in dose, but if you're wanting to have it be a little lower so you're less nervous, that's ok for the moment. And as you saw today, a little sugar water made you able to steer his blood sugar. It rose up very nicely. You will be able to steer his blood sugar like that again and he will respond to the carbs you give him. Next time it might be easier to use a couple of drops of honey, karo syrup, maple syrup, or if you have some gravy cat food, you can squeeze the gravy out and give a teaspoon or so if it. Any of those options are probably easier than trying to make a sugar water solution.

Cats develop more capillaries as their ears are poked. It seems to take about 2 weeks, and then you should get blood every time you poke. In the meantime, the poking is stimulating the capillaries to grow, so it's still doing something. Are you putting Neosporin with Pain Relief Ointment on his ears? I slathered quite a bit on punkin's ear at night and it was healed by morning. Wiped it off before the first morning test and he was good to go for the day. If you don't have that where you are, look for a Polysporin with pain relief or something similar. It's the pain relief that's the important part, although you can't use teething pain relievers on cats. A treat after poking will soothe his dignity and make the whole thing easier.

Great job handling things today! It will get easier and less nerve-wracking.

 

Since you are in Canada, get the Polysporin Complete - it's the tube with the black and yellow label. It's available in any pharmacy, first aid section.

 

Holding the Pokie spot gently but firmly for about 30 seconds after the test will also help with bruising and prevent scabs.

I also think you should hold the 4 unit dose for a few days now that you've gone there. Do not be tempted to increase again based on the high numbers you're likely to see for the next few days. Lantus doesn't work like that - adjusting each dose based on preshots - you have to hold it for a few days to see what the dose can do. The bounce numbers may continue for up to 6 cycles - 3 days. Time to put on your patience pants