911 Salems levels dropping

Salem 14yr old male has been on Lantus started end febr. Diagnosed at 510 level. Vet started him on 1unit which we did cpl weeks. His levels were staying btwn 350-450. We increased to 1,5 for week then 2units becz levels wldnt come dwn. He's been on 2.5units this week. Today first real change. Today's per shot was 151. We only gv him 1unit. That was 130today. Tested 2hrs aftr. It was 57. He ate gave a few treats tested an hour ago it's 178. Will test befr shot at 130am. At least numbers coming dwn! I'm wondering abt chicken fancy feast. We took that out of his selection 3-4 days ago. Not sure if that has anything to do with lower numbers. Also young again zero carb food hasn't had 3days since we r out of it. Any comments/advice would b appreciated. Thks Sheila

 

Hi

Please keep testing him regularly as he may well drop lower again.

Changing food can have a big impact on blood glucose levels and this may be the what is affecting it or it could be the increase in dose of lantus.

Have you been testing Salem during each cycle to check how far he drops and that is how we adjust the dose of lantus. We also recommend that you only adjust the dose by 0.25 at any one time. Have you got the readings recorded anywhere as I think you need so,e advice on dosage and the numbers are going to be helpful here.

Hopefully @Wendy&Neko @Chris & China can help here. @Tricia & Cinco @Marje and Gracie

 

You can find nutritional information of different canned foods here: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

 

I don't hv a spreadsheet but we hv the numbers written dwn with dates/times. We will do a curve today. I've noticed he hasn't drinking/peeing as much as before & looks more like himself. Nite that his diagnosis came after a **** if Depo for lip sore.

 

It would be great if you could list out the numbers. Are you aware of the two protocols that we follow on the forum?

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

Tight regulation
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol.1581/

The recommendation for both is to increase by 0.25 unit and monitor but if they drop below 50 then they also earn a reduction by 0.25. I would read through both links and look to follow one of them as they have both had great success for kitties on the forum.

You will need to decide on the dose going forward from today. I know that you dropped to 1 unit but the deposit had already built up in Salem's system. Hopefully others can advise.

 

I agree with Sarah. I think you should test regularly through this cycle. The carbs from those treats might wear off and because of the insulin depot built up on the higher dose of Lantus Salem's BG might start dropping again during the cycle.

 

So not sure which dose to give now. We couldn't test befr shot becz cldnt get blood. I stayed with 2units today. Down from 2,5. Will test in an hour.

 

Hi Sheila,

Thanks for the update. Be sure to keep posting the results here so that members can keep an eye out for you both in case you need help.

ETA:

If Salem goes low again and you need more eyes on this thread, go back to the first post, click on Thread Tools (right-hand side of screen on a PC), change the prefix to 911 and edit the title to show you need urgent help.

 

Hi Sheila,

Can I just clarify:
How many hours ago did you give insulin?
What is your most recent blood glucose reading?

Eliz

 

We do every 12 hrs. Last shot was 115.

 

Last shot was at 1:15pm. Will test soon. We gave 2units

 

Hi

Have you got any updates re glucose readings? You may get a bounce after the low level tonight. I will ask for others to comment.

If you could list out some of your recent readings that would be great. You see getting some mid cycle readings aren't you?

 

You can set up a spreadsheet to attach to your signature, instructions are here

http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

Your vet will also be able to access the data if you send them the link

We really can't offer any advice without the numbers

 

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

We just tested now before shot. It's low again, 60. Do we not give the shot?

 

I can't give advice but will contact someone. Don't give shot yet @julie & punkin (ga)

 

no, you should not give the shot. that's too low for you to shoot.

I'd suggest you skip tonight's shot, test again in an hour and make sure Salem's not dropping lower.

then if you could please get a spreadsheet going - it's really an essential tool for us to be able to help people. Because of the way Lantus works, all the tests matter in the context of how long since the last shot and in comparison to the previous 3 days or so of blood tests. You want people to be able to help you and the spreadsheet lets us do it best.

 

Ok ty. We won't do shot. I'll set up spreadsheet now & plug in all the info. Thx for ur help!!

 

great! and thanks for replying - once in a while people just don't come back and then i always worry about their cat!

You can shoot early in the morning since you are skipping tonight's shot, so if you want to change your shot schedule, tomorrow morning is an opportunity.

I would check him still in an hour and make sure he's not dropping lower.

 

Just in case, though it sounds like you're doing okay, here's the link to the hypo page. It's often a good idea to have that information printed in a hard copy form.

Also, @BJM's Glucometer Notes will help to let you know when it is or isn't safe to give a shot. I found them to be a great help and an excellent guide to keeping my kitty safe.

 

Ok we tested at 230p today before shot. His level was 420 so we went back to 2units. We skipped last nuts shot since his reading was too low. Why is it jumping like this?

 

He's probably bouncing. From your initial post, it sounds as though he'd been pretty constantly between 350 and 450 until very recently. What happens is that his body gets used to the level it's been at, then as soon as he gets a significant drop from that level (even if it hadn't been into particularly low numbers, although that 57 was an impressive drop!), his body thinks it's going too low and his liver starts to pump out glycogen to bring him back to the level his body thinks is 'safe'. Of course this pushes his numbers right back up. It can last through a few cycles (up to 6) or it can clear fairly quickly - that depends on the cat. The longer he spends in healthy numbers, the more his body will get used to it and he'll stop bouncing after every lower number he gets. For now, as it sounds as though it's the first number under 100 that you've got, I'd say him having a bounce is completely normal (or as normal as anything about this whole thing gets).

 

So are we good to stay .25 under the 2.5units we were gvg him or go back to the 2.5u??

 

That's a slightly more complicated question to answer as it does depend on the meter you use for testing and which of the Lantus protocols you're following (if you're aware of and following either fully).

If you're using a human glucometer and following Tight Regulation, then he needs to go under 50 to earn a reduction. However, if you're using an Alphatrak meter, then the number for a reduction is below 68.

If you're following the Start Low Go Slow protocol, then the reduction number on a human glucometer is if he falls below 90. I'm not sure of the equivalent number on Alphatrak for that as the protocol notes in the Lantus/Levemir forum only give the human glucometer number, but if we base it on the 35% difference, then that would be around 122 - maybe someone else can confirm that?

As you can see, depending on the meter and protocol, he may have earned a reduction or he might be just short of earning one. Either way, it looks as though this dose is taking him in the right direction.

 

I think that if he was too low to give the shot earlier then that indicates that the dose might be too high and so I think a reeducation is due but hopefully @julie & punkin (ga) can give further advice.

Please get that spreadsheet sorted out, then you will be able to post over on the Lantus forum and many more people will be able to help you.

 

The only dosing option available for a cat eating any dry food at all is the Start Low Go Slow method. I don't have enough info to comment on the dose.

If you need help with the spreadsheet just ask, either here or on the tech board.

 

We use the Relion Confirm meter & when we took him to vet it was 5% difference in reading. We did shot today at 230p (skipped last nite 1230a shot becz levels were too low) reading at 230was 432 preshot. Gave 2units. Just tested now & it was same 433. Is this becz we didn't give shot at 1230a? It's so frustrating!! I'll set up spreadsheet now. How often should e test? Salem is not drinking as much, not even close to what he was last week or urinating as much. He's acting like his own self & looks better. The Young Again Zero carb dry should be here tues morning. He hadn't had any dry for about 4dats so I've been feeding FF classic more often (approx every 4.5hrs 1can split btwn the 2cats). Advice would be appreciated. Should I go back to 2.5units (the dose that seemed to have some effect)?

 

Thank you for the extra information - I use the Confirm too for Rosa. It's good that your meter only differed 5% from the vet's one - that's really very little difference at all between any 2 readings. I think he's probably still bouncing - it's hard to be patient but it can take up to 6 cycles for him to clear a bounce, especially when he's new to lower numbers. That would make his numbers rather higher than you'd expect and also slightly unpredictable for the next day or so - at some point he'll break the bounce and head back into better numbers so that's something to look out for when it happens.

And you're right that symptoms can start to improve a lot even before a cat is seeing consistently normal numbers - Rosa definitely started to feel better after just a few days on insulin even though her numbers still looked fairly horrible for the first week or so. Salem is a lot more than just his numbers - how he's feeling and acting are also very important so it's great to hear that he's feeling and looking better!

As Julie said, without the ss info (I notice you're going to work on it which will really help ) it's very difficult to offer information on dosing. The 57 on SLGS would at least earn him a reduction of 0.25 of a unit but as you'd given him a smaller dose than usual when he got to 57, that might not be enough of a reduction in this instance.

 

I can't upload the spreadsheet to my tablet. Is there anyway someone could email the sheet to me? Sjewell77@yahoo.com and I'll start putting in salems info. If needs to be Google my email is samueljewell38@gmail

 

For a tablet, it might be the same issue as I had with my phone - I had to install not only Google Drive but also Google Sheets to be able to do more than view the ss. I can email the link to the template, but if you can't open it I don't know if that's going to help?

 

Instructions for iPad are here: http://www.felinediabetes.com/FDMB/threads/setting-up-ss-and-link-from-ipad.132773/

If you're doing this from another type of tablet, the only big difference will be that you will need to download Google Drive and Google Sheets from wherever you download apps. The links in the instructions (for Google Drive and Google Sheets) take you Apple's AppStore. I'm not sure what mobile browser you're using, but the instructions include directions for doing this with the Chrome browser too, which you can download for any sort of tablet.

 

I was using iPad but I'll try later from laptop.

 

We tested now preshot & it's 62. When it's this low I don't know what to do? Do we give 2.5 or lower or skip??

 

62 is a beautiful normal number. No shot.
You can stall; ie wait maybe 20 -30 mins without feeding to see if the number comes up to a shootable level, but I seriously doubt that it would rise sufficiently in that time....

 

Without a post history I would not give any insulin at 62. The rule without history is no shot or below 200.

 

So how do we get him regulated? When we skip shot & wait another 12hrs the preshot will prob be back in 400's? Does this go on for days??

 

If your kitty is repeatedly dropping too low to shoot, and then swinging up high by the time of the next shot, then you may want to consider lowering the dose to level things out a bit, and so that he is shootable at both am and pm.
(I don't know if that is the case with your kitty, because I've not seen any other data for him.)

Don't lose heart. I'm sure there are things you can try.

 

When you get the spreadsheet up and running, it will be really helpful for you to enter all the data you've gathered thus far. If you need any help with setting up the spreadsheet just holler.

To give you some background, the objective with Lantus is to aim for a dose that produces a fairly smooth curve throughout the day. It can take time to get to that point. The data in the spreadsheet will give you a much better picture of how a given dose is/isn't working for your kitty.

In the meantime, I very much recommend that you let your vet know that you've been getting quite low numbers on the 2.0 and 2.5 unit doses. As a matter of course, we always recommend that new members fully acquaint themselves with the hypo guide (link above) and also that they print out a copy and put it in a prominent place so it's quick and easy to find should it be needed for reference.

 

we just tested him now (note, no shot today since his level was low). Now it's 140 - we're trying to figure out when to shoot because tmrw we will be out for most of the day, for an appointment for my son, til probably 1pm or 2pm, so I'm wondering if we should hold off til at least midnite to do next shot so we are not way off schedule for tmrw. Any advice? I'm setting up my spreadsheet now for Salem. Hopefully I'll have success this time!

 

Hi Sheila,

I'd suggest going back to your first post and changing the title to indicate that you need dosing advice asap.

 

We are now going to another vet as the one we were seeing is not really capable of helping us. I have an apptmt on 4/18 for Salem. We have to see what is on his top lip (looks like a rodent ulcer) and the prior vet didn't want to deal with that until we got Diabetes under control. (Note that we initially took Salem to vet for the sore on his lip and this is when they gave him a shot of Depo-Medrol) and then about 3wks later he developed Diabetes. She thinks it definitely was a result of the Depo shot. THe vet we're taking him to is a holistic vet and she was referred by a coworker. Hoping she can help Salem w/the lip issue and also w/the diabetes.

 

Now you have your spreadsheet up and running hopefully @julie & punkin (ga) will be able to offer some advice.

 

@sjewell, do you have your spreadsheet set up to be shared? When I tried to look at your spreadsheet it wanted me to sign in instead of just bringing up the spreadsheet as it should. You may want to double check your settings.

 

You did not make your spreadsheet public. The link returns
You need permission

Want in? Ask the owner for access, or switch to an account with permission. Learn more

You are signed in as my Google email address

Request accessSwitch accounts

 

You want to choose the option of publishing it to the web and making it so that anyone with the link can view.

 

OK, I fixed the spreadsheet, hopefully it works now. Note that we didn't give him a shot today since his reading was 78. We will check again later tonite. I think we may need to adjust the dosage from 2.5 to 2.25 tonite, if he's good to go (if his level rises).

 

Yay! It works!

Sheila, let me see if I have the story right. Salem was diagnosed 1/2/2015. He's no longer eating dry food, right, but he was when diagnosed - was he eating the zero carb before, or some other dry food?

Is Depo a steroid? If so, yes, steroids can induce diabetes in cats.

There was another cat on here a while ago that had the rodent lip thing - i think it's called e. granuloma. His person found that there was a relationship between the skin outbreak and his blood sugar.

One thing that's helpful to know is that there are a couple of times when a cat has high numbers that it doesn't mean that they need more insulin: sometimes when a dose in increased a cat will react with higher blood sugar for a couple of days. We call that the very official name of "New Dose Wonkiness." The second occasion is when a cat is bouncing. If a cat either goes into a range of blood sugar that's lower than their body has become used to, or if a cat's blood sugar drops fast, the cat's body will respond by releasing hormones and stored sugars to send the blood sugar back up high. There's a longer explanation of it & NDW here. The difficulty with making dose adjustments at the vet's is that if you happen to get a test during either NDW or a bounce, it can make it look as though the cat needs more insulin, when in fact, they might not. The way to be confident about the dosing is to test at home - which is what you're doing. Kudos to you for mastering it - it can be a challenge at first but it becomes routine before long.

When you're having to skip shots because he's too low to shoot, especially after just starting out, it likely means the dose is too high.

There are 2 dosing methods we use here. Someone linked them to you above. With the Start Low Go Slow method, a cat begins at 0.5u if they are on canned food only, and the dose is evaluated with a curve once a week. Dose changes are then done by 0.25u increments (one quarter of one unit), based upon the results of the curve.

With the Tight Regulation Protocol, the starting dose is determined by weight, then adjusted by 0.25u or 0.5u increments, depending on how low the cat's blood sugar has been getting over the previous 3 or so days.

How much does Salem weigh?

Regardless of whether you want to follow SLGS or TR, you have to know how low the dose is getting Salem in order to know how to adjust the dose. The low point with Lantus is typically somewhere between +3 and +8 or so during the cycle. So it becomes critical to either do a curve before adjusting the dose or to do mid-cycle checks. It's really the only safe way to use insulin.

Let us know the answers to those 2 questions above and if you could take a look at the dosing methods and let us know what you want to follow, then we can figure out how to help you move ahead.

 

Based on the data in your SS I would not have given 2 U with a PS of 133. You may see a high PS the next morning because Salem dropped too low and the bod compensated by the liver dumpin glycogen into the blod stream.

 

Yes he was diagnosed 1/2/15. He ate dry food all his life. At tine of diag I was feeding him & my othr cat who is 13, science diet mature indoor. They had canned friskies all kinda not just pate. I took them both off dry after diagnosis & switched to FF only. I read up abt Young Again zero carb so tried that. They both love so I got some in march. Went thru 4lb bag so ordered another which we recvd yest. Salem had depo shot for lip in dec & had diabetes 4wks later. He started at 12lbs in dec. dropped to 9.9 aftr 4wks. He's not abt 10.5 14 yrs old. His preshot reading today was 150. We didn't do shot. We didn't do yest either becz it was lower so he's been without insulin for 24hrs. I agree that dose of 2.5 has started wirking but may need to lower it. I need to do a curve on him. Thks for ur help