Pls help. 27.3mmol worry hyperglycemia

My cat MIKO 13years old was diagnosis diabetic on July 2010 & OTJ 6 month. But honeymoon is over get back to insulin on this March 21,2011. Yesterday March,28
19.3mmol at 2.00pm, we have monitor every hour and MIKO test drop to 3.8mmol at 10.00pm. After 1.10am MIKO blood glucose test start to up to 6.2mmol until now 6.45am (Malaysia time) is 'Hi' ? then i check blood again for the second time is 27.3mmol . What to do...... Please help. In my town there is no 24 hour Vet. Now miko still eat & drinking water & grooming like normal but we scare his blood glucose level is going up to hyperglycemia. Please help...

Just now at 7.00am Miko test is 24.5mmol. Already drop abit. Please help.

Thanks in advance,
Theng

 

take a deep breath ok. hyperglycemia for a short while is not dangerous. it is when you have it for days or weeks wherein it can be the most dangerous.

was he seen by a vet now that he's back on insulin? and if so, did they find any underlying cause for the rise in glucose levels, i.e. infection, injury, etc.....? and does he have any history of ketones?

and last but not least, can you remind us which insulin you use?

 

Hi Theng,

Can you tell us what insulin and dose you are giving Miko? Also, please tell us what time he gets his shots.

Please try not to panic. The fact that Miko is eating, drinking and grooming are all good signs. And with his numbers starting to come down a bit, even better...

Hugs from the other side of the world for you both,
Deb and Nikki -- and Giz, forever dancing in my heart...

 

We also don't know why he have to back to insulin . Lab work came back showing normal only Low Platelet count : 46,000 * & Urea : 116mg My vet recommended solapen but we use sterile micro-fine needle not same as US . March,19 -25 we start 2 unit at 11.30 am & pm still no drop and the glucose level around 15.4 - 23.6mmol. March,26 3 unit at 11.30am & pm and until March,28 BG drop to 3.8mmol at 10.00pm we put insulin 1unit on 11.45pm (4.8mmol) This morning more higher that usual ... the level up to 'HI' and test second time 27.3mmol.

Just now at 7.35m Miko test is 25.9mmol.

 

I remember you were using Lantus, right?

So the vet had no idea why Miko needed insulin again? What kinds of tests did they do?

Cindy is absolutely right. While high numbers are scary to see, low numbers are much more dangerous.

Have you tested for ketones before when he was on insulin? Do you have the strips to do that again?

 

Have you tested for ketones before when he was on insulin? Do you have the strips to do that again?

Sorry i dont understand strips? we only use Abbott blood glucose test strip. over 16.8mmol is ketones. Do u mean the blood glocose strip?

 

Diabetics can test for ketones in the urine. It is a good idea when bg levels run high. You use the ketostix that human diabetics use and test his urine.
Here you buy them in the drugstore.

 

How much insulin are you giving?

 

So I am trying to figure out your numbers. Remember, we use US numbers and multiply yours by 18.

2pm. 342
10pm 72
1am. 104
6:45. HI
7am 450

Does that sound right? When was your shot within that cycle?

 

March,19 - 26 is 2unit at 11.30am &pm.
March,27 - 28 is 3 unit at 11.30am & pm.
March,28
4.10pm - 14.4mmol
7.18pm - 7.2mmol
8.50pm - 5.9mmol
10.00pm - 3.8mmol
10.33pm - 4.0mmol
11.48pm - 4.8mmol (1unit)

March,29
1.10am - 6.2mmol
3.10am - 9.2mmol
6.10am - HI
6.15am - 27.3mmol
6.55am - 24.5mmol
7.35am - 25.9mmol

Today will go to pharmacy to but the test urine strips. But if is ketones is that dangerous?? Thank you.

 

Good. The way you wrote it is easier to understand. When did you give the shot today and how much?

 

Or maybe I misunderstood. You gave one unit last night at 11pm and haven't given your next shot which would be 11am?

 

Thank you so much to all response .Sue im not sure 2 unit or 3 unit at next shot 11.30am. My vet not much experience in diabetic .I learn so much from this forum.

 

I don't remember how long you were on Lantus before. There are two things to consider. The insulin builds up a shed, so it tends to work after several days of that build up, at first.

And it is usually best to stick with one dose for several days.

I do not know your insulin well. It is not what I used. I have asked someone who posts on the lantus support group to come over, but I understand it is about time for miko's shot.
I hope someone who uses Lantus will give you dose advice before you have to shoot.

Did you read the information on how Lantus works and how to give doses? It is explained on this page just below the grey line:

viewforum.php?f=9

You could also post on that page. They all use your insulin and could help you figure out the dose.

Ketones can be dangerous. They usually happen when a cat's numbers are high, there is an infection and the cat isn't eating. This does not sound like Miko. But they would be a good thing for you to have and get tests every so often.

 

have you used lantus before?

i'm thinking your high numbers today could possibly be rebound from the big drop you had yesterday (you are about a day ahead of us it appears, timewise)

it might be best to start back at 1 unit twice a day, get urine strips to test for ketones, and work your way up slower in dose. generally with lantus you don't increase by full units all at one time. so you might have started too high at the 2 units and then by increasing to 3, you actually ended up giving too much.

also, lantus doesn't necessarily work right away. it builds up in their system so you won't see it working it's best for at least a couple days possibly, thus the sudden drop in levels you got yesterday.

 

Thanks u so much Sue. Thanks for all information .I will update Miko news&BG level. Now have to prepare go to ask vet & buy urine strips. Thanks again. Very Appreciated .

 

Please consider posting on the Lantus support group. Be sure you tell them you are a newbie and need dose advice. It is a much busier board than this one but they all use your insulin and can help you figure Miko out.

 

Welcome Theng. Sue asked me to stop by.

When beginning to use Lantus, you want to inject the same amount of Lantus for 5 - 7 days. As Sue and others noted, it takes this amount of time for the dose to begin working. Further, your dose is NOT based on your pre-shot test data. Lantus dosing is based on the nadir. I put your records in a format that most people here understand -- we do not report blood glucose in mmol/L. We record our blood glucose in mg/dL From your information, you started Miko at 2.0u of Lantus? This may have been too high of a starting dose.

March 19 - 26 - shot 2.0u
March,28 -- began 3.0u on March 26
4.10pm - 14.4mmol -- 225
7.18pm - 7.2mmol -- 130
8.50pm - 5.9mmol -- 106
10.00pm - 3.8mmol -- 68
10.33pm - 4.0mmol -- 72
11.48pm - 4.8mmol (1unit) -- 86

March,29
1.10am - 6.2mmol -- 112
3.10am - 9.2mmol -- 178
6.10am - HI
6.15am - 27.3mmol -- 491
6.55am - 24.5mmol -- 441
7.35am - 25.9mmol --466

The lows that you were seeing are not dangerous. It is best to have someone helping your who is familiar with managing low numbers with food, though. The numbers you are seeing are what we call a "bounce." When a cat experiences numbers like you saw on March 28, the liver dumps a stored form of glucose into your cat's body and the numbers rise. This is normal. You need to keep the dose consistent because the bounce will clear. If you increase the dose and the bounce clears, you will be giving too much insulin.

This is what I would suggest:

• Reduce Mico's dose to 1.5u or 2.0u at the most. (Do you have syringes that are marked in half units?) If you are using the needles that come with the pens, using a regular syringe is much better. The pens will only allow you to dispense in full unit amounts. If you follow the Lantus dosing protocol, you will need to increase or decrease doses in the amount of 0.25u.
• Please familiarize yourself with the information on Lantus that's on the Lantus support Board.
• Testing as frequently as you were doing this morning isn't necessary with high numbers. It's very important to test often if a cat is experiencing low numbers, though.
• Talk to your vet about why Miko is needing insulin again. Make sure there is no infection, that your cat doesn't need a dental procedure for gingivitis or an infected tooth, and depending on how old Miko is, make sure your cat isn't hyperthyroid.
• Set up a spreadsheet so we can better help you. Please use the World template in this link.

Here are links to the information on the Lantus board:

• Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
• New to the Group: Everything you wanted to know about the Lantus forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
• Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
• Lantus depot/shed: This is an important concept for understanding how Lantus works.
• Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.

 

{Reduce Mico's dose to 1.5u or 2.0u at the most. (Do you have syringes that are marked in half units?) If you are using the needles that come with the pens, using a regular syringe is much better. The pens will only allow you to dispense in full unit amounts. If you follow the Lantus dosing protocol, you will need to increase or decrease doses in the amount of 0.25u. }

Hello Sienne and Gabby,
My vet said 2u for 11.30am. Pls see above photo we use Sterile to shot insulin just turn 2u and then push upper button. The solarpen only have 1U,2U, 3U... dont have 0.25u or 1.5u. Before OTJ 6month we also use this solarpen start with 2u & 1u to OTJ. I will learn to set up a spreadsheet. Thanks u so much for your help. Now i try to do spreadsheet.

 

This link explains how to use the pen with a syringe to do smaller doses:

viewtopic.php?f=9&t=151

 

Hello , just now we give Miko 2u insulin at 11.35am (23.7mmol = 426.6). My vet said don't worry for high BG is does matter only scare low hypo level. :shock:
Sue I saw the solarpen photo from viewtopic.php?f=9&t=151 same like i use but we does not use U-100 syringes to draw insulin. We use Micro-fine 0.25x5mm sterile to shot insulin just like human use. Turn 1unit or turn 2unit and then push the button to inject. Like I post above photo. I'm not sure is it better to use syringes to draw insulin and inject it to Miko but this is my vet teach me.I will try my best to make Miko better. Thanks so much to u all. Now i try to do spreadsheet. :smile:
Any help is greatly appreciated.

 

I really would post on the Lantus support group. They can help with the solar pen and with your dose.

If you have trouble with the spreadsheet, just ask for help.

 

Pls help i have trouble with the spreadsheet, i step by step follow http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 when i click on Outside of USA (mmol readings) click here: WORLD INSULIN TEMPLATE pop up another link then Click on "USE THIS TEMPLATE". But when i click "USE THIS TEMPLATE" nothing come out the page is done nothing pop up. Is already sign in please help .

 

Theng:

For dosing Lantus, giving a dose in ONLY 1.0u amounts (such at 1.0, 2.0, 3.0) is a problem. It is a problem because many cats -- probably most cats -- need doses that are between these amounts. This is why we recommend using a syringe that is marked in 0.5u amounts. There are many cats who get a dose of 1.25u. From what you have described, you can't do this with the syringes you are using. Please consider getting U100 human insulin syringes to use with Miko.

 

Try this one: https://spreadsheets2.google.com/ccc?hl ... l=en#gid=0 We have been having trouble with the link. This one is Public on the Web. You want to change it to Anyone with this Link. Then follow the directions. The cc url is yours; you need to choose Share to get an url we can all see.

If you have trouble, just send me a private message. (pm button on the left hand side of my post) We can try doing this by emailing back and forth if you have problems.

 

Hello Sienne and Gabby,
Above is the unit insulin came out from the solarpen. This solarpen is my vet recommended the only option that i can choose. I thing the dose is less that U100 human insulin syringes.

 

Hello Sue and Oliver,
Thank you so much, i can make my MIKO spreadsheet . Thanks a lot. But now already 12.20 am (MALAYSIA TIME) . A bit tired. Have to go to sleep. And get up test blood every 2 hour. Hopeful my sister can help me at night. Tomorrow will continue spreadsheet . Thanks again.

 

You can use the SoloStar pen.

The problem is that if you use it the way Human diabetic does (with the pen needle that attaches to the end of the rubber stopper), you can only measure whole units. And you're not quite getting the full whole unit either when you inject.

Cats may need half and other smaller unit doses. That is why members who live in the US, Canada, UK, and other places use U100 insulin syringes with the SoloStar pen. You just stick the insulin syringe needle into the rubber stopper. I'm sure your vet can write you a prescription for U100 3/10 cc insulin syringes with half unit markings or be able to tell you where to buy some in Malaysia. Maybe you can ask your own doctor where to buy U100 insulin syringes?

How a Human diabetic uses the SoloStar pen: http://www.lantus.com/images/hcp/charts/breakout.gif (Couldn't get the picture to show up in post)

How a diabetic cat uses the SoloStar pen:

 

Hello and welcome
I was asked to stop by and help with your spreadsheet although I do notice your picture.

Are you using a syringe with the pen or are you dosing with the nob?
This is very important that you insert a syring into the little grey end of the pen and not use the needle that you attach to the pen. The measurements are not as accurate.

Here for your spreadsheet, please follow these and be a little patient in loading.

1. Log into your google account
2. Click on documents
3. Click on Browse templates
4. Type in the box: fdmb world insulin and click search templates
5. a picture will come up and click on use template
6. Once it loads click on make a copy or rename it and call it your "kitties name" spreadsheet

You might want to go back to tech section and follow the notes on how to publish it and share it on the web, that is not my expertise.

I have tried it a few times and it seems to load. You might need to try a couple of times.
It appears to be fussy sometimes.
Your mmol numbers need to be entered in the tab that says mmol and they will be automatically converted into the US tab. Try and keep you ss set to open to the US tab so
when people are lookimg at it it is easier for them.

I hope this helps.

 

Hi Theng,

You can use the U100 human insulin syringes with the solostar pen. It is better to use the U100 syringes because most cats need 1.25u, or 1.5u of insulin, and you can't give this dose with the needles that you are currently using with the pen.

Here is a video that might show you better: http://www.youtube.com/watch?v=sAm5VaXijZU

Here is another video meant for humans, but it is the same way for pets: http://www.youtube.com/watch?v=NfgyaWHc8vY

You can ask your vet for a prescription for U100 syringes to use with your solostar pen.

 

Sorry every one for late reply. I already finish the MIKO spreadsheet. Pls teach me how to put the link at the bottom each post.

MIKO spreadsheet : BG level still HIGH. https://spreadsheets2.google.com/pub?key=0ArX2GQcDdjn5dHZKeTU1X0d2TmQtZlV1YXU0aDd0T2c&output=html

Hi squeem3, Randi & Max & Julia & Bandit, yes we are using Human Human diabetic uses the SoloStar pen: http://www.lantus.com/images/hcp/charts/breakout.gif .
My vet didn't teach me use the U-100 human insulin syringe. I will try to ask her . Thanks you so much for those info & video . I will do the best for MIKO. Any help is greatly appreciated. THANKS THANKS THANKS SO MUCH.

Regards,
Theng

 

To attach the spreadsheet to your signature, go to Control Panel, then Profile, then Signature.

Highlight, copy and then paste the URL into your signature. The URL is working. remember to Submit. we can see the spreadsheet.

Now, time to post on Lantus and have them advise you on doses.

Great job on the spreadsheet!

 

Hello Sue,
Thank you so so much. i already post to Lantus . Thank you for your help.



Best Wishes,
Theng

 

There's not much to using a U100 insulin syringe. Just be sure to familiarize yourself with the markings and understand them. Make sure the plunger is all the way pushed in when you stick the needle into the rubber stopper. You do not want to get any air inside the SoloStar pen.

Your vet can show you how to use insulin syringes. Practice on a bottle of saline or use a cup of water until you are comfortable with using insulin syringes and how to measure doses.

On 3/10 cc (30 unit or 0.3 ml) and a 1/2 cc (50unit or 0.5 ml) insulin syringes, the markings are in single whole units (1, 2, 3, 4, 5, etc). The one exception is if you have half unit marked 3/10 cc insulin syringes which in that case the markings are for every half (0.5) units. Like this:




On a 1 cc (100 unit or 1 ml) insulin syringe, the markings are for every 2 units (2, 4, 6, 8, 10, etc).



Here are pictures of how to measure insulin with insulin syringes: http://steverapaport.com/jock/SyringeFineGradations/

And see the pictures in the Lantus sticky to see how you actually use an insulin syringe with the SoloStar pen: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

Ideally you want the 3/10 cc insulin syringes with half unit markings. That specific type of insulin syringe is more than enough for a diabetic cat. If you can't get 3/10 cc insulin syringes in Malaysia, try the 1/2 cc ones. I wouldn't use the 1 cc ones because of the fact that it only has markings for every 2 units which makes it harder to accurately measure insulin if your cat needs an in between dose.

 

Hello squeem3,
Sorry for late reply, Thanks you so much for all your info insulin syringes photo. I find at pharmacy only have BD ultra-fine only 30 gauge needle. Don’t have 31 gauge needle 1/2 unit markings. But my vet not agree us to use it. She still recommend us to use the Solapen with human syringe like above photo coz last time have remission before. We got no choice, today 11.40am we shot 3u at am and will shot 2u at pm. This morning Miko vomit but still eating and playing as usual. At 8.55am (malaysia time) pee and poo still ok and normal but at 9.05am Miko have problem when he go to pee. Miko pee about every 2 to 5 minutes around 18 times (small clump) and Miko meowing when pee. Call vet, Miko have to eat antibiotics & also need to test urine again. Hope not kidney and bladder stone......

 

Your vet is not using the Lantus in the way that will best get back Meko back to regulation. I don't know whether you are willing to go against his wishes or not.

Lantus works best if you give the same dose am and pm over several days before changing. Changing the dose amounts twice in one day will make this harder. And it should be increased by .25 units when increases are done - not whole units. Have you read through the starred topics under the grey line at the top of the Lantus support group: viewforum.php?f=9 The methods described there have helped many cats.

I know you don't have many choices about vets or insulins. I would suggest that you post over on the Lantus support group, tell them that you are limited by the dose changes and see if they have ideas to help you.