Unregulated glucose levels with Lantus

http://www.felinediabetes.com/FDMB/...ice-on-cat-not-eating-after-diagnosis.214220/

Hello!
My Mimi was diagnosed with diabetes about a week ago and it has been very hard to regulate since.
The initial dose of 2units of Lantus landed her in ICU for three days.
We reduced her to 1 unit but as you can see from the SS, even that cause hypoglicemia episode.
She is now no .5 unit and yesterday there were 2 episodes of hypoglycemia. Because of that we are unable to follow a normal schedule.
She has always refused wet food and now we need to force feed her at the time of injection. She begs for dry food and the vet gave us the Royal Canin Glycobalance to give her but it is all carbs. How can that be good for her?
Her UTI seems resolved and her ketone tests are negative now which is a relief, but her glucose levels are all over the place. Being unable to keep her on a 7am and 7pm schedule, how can I go back to work?
Why are her values so low even with only .5 unit?
Can I inject if she refuses to eat a proper serving of food? All this force feeding is making us very upset.
I have a link to my introduction post . I am so grateful for any advice.
She weighs 9.7 pounds now and she is 13.5 years old.

 

Welcome. She is bouncing from reaching numbers lower than she is used to being in. I suggest you read the yellow stickies which explain how this insulin works. That she is reaching green numbers is a good sign. Also the UTI once resolved could lower her numbers. Normally we increase and decrease in .25 increments.

 

Thank you. Not only I am new to diabetes but also to ever going online so apologies if Im not posting correctly.. Necessity is the mother of all inventions so I will get there. I will try to repost with numbers once I figure it out..

 

When you say that Mimi was hypoglycemic the last few days, was she showing symptoms of hypoglycemia or did you mean she was in low numbers? It sounds like she was in the hospital but it sounds like the larger concern was the DKA.

Just to provide a bit of background... Numbers above 50 do not usually cause symptoms of hypoglycemia. In some cats numbers that low may cause symptoms but it's not typical. You don't want numbers to drop further because it can be a slim margin of safety. We encourage members to differentiate from low numbers vs symptomatic hypoglycemia.

When numbers drop into a range a diabetic cat is not used to spending time in, the liver and pancreas release a stored form of glucose along with counterregulatory hormones. The result is numbers spike upward. We call this a "bounce." It's what you're seeing when number rise from the greens into reds and blacks

Ketones, on the other hand, if above trace levels, are an emergency. This is why several people were suggesting you get ketone strips and test for ketones regularly. Cats who are showing ketones feel lousy. They are lethargic and don't want to eat and they need to eat and they need insulin. It's great to hear that Mimi is going better but I would still encourage you to test for ketones. DKA is dangerous and expensive and the best prevention you can do is to test!

I know it seems like Mimi's numbers are all over the place. They really aren't all that unpredictable. There are a couple of things to consider. First, she was started on too high of a dose. In a perverse way, that dose allowed her to get the DKA diagnosed. Because one of the contributing factors to DKA is an infection (the UTI), once the DKA and UTI clear, numbers drop. Infections or inflammation raises BG numbers. So, putting a cat on antibiotics clears up the infection but numbers can then drop.

I'm glad to see you've lowered the dose so you can shoot twice a day. One key issue with DKA is that skipping a shot is often not a great idea. Insulin helps to keep ketones from developing. What time are you shooting now? There are ways to move shot times but it's helpful to know how far off schedule you are.

Is Mimi eating at all on her own? She doesn't need to eat her entire meal all at once. Lantus doesn't kick in for a couple of hours. If your cat was a grazer, it's fine for her to continue to graze. If you need to slowly transition her to canned food, that's really OK. This is a piece by Lisa Pierson, DVM on transitioning a dry food addict to canned food. You may find it helpful. I agree with you -- if you need to find a dry food that isn't horribly high in carbs, there are a few out there and Glycobalance isn't one of them.

 

Looks like you are using a pet meter. If correct you don’t want her under 68 andsince feeding dry food that number is actually 90. While feeding dry food you want to follow our SLGS protocol so the 66 required a dose reduction. Since you went from 1 unit to .50 I would stay with that dose now.

No need to apologize. Ask any and as many questions that you have. Someone’s almost always around to answer. One dry food to try is Dr. Elseys Clean Protein available from Chewy.com or their site although if your cat will eat canned food it’s generally better for diabetics.

 

her schedule has shifted from 7am to 7pm to 10am to 10om now with .5 unit of Lantus. We check her ketone levels daily and they seem negative for now. It seems that she only eat alone in between shots but when it is time to eat, she just refuses.
Mimi gets lethargic but most of all her eyes get glassy and opaque and that is when I can tell her BG is low. Every time i see that and I test she has been in the 50s range. Our vet told us she can never drop below 68 using the Pet Trek 2, so on our first week of all this, we were overcompensating with kibbles to get those levels up. I am starting to feel less panicky now but I wish I could find a way to stabilize her.
I will check the Dr Elseys and also I read about Young Again Mature. Thanks for the help!

 

Many vets insist on pet meters but some human meters work just fine. The protocol used most here originated using a human meter. It takes time for most to get regulated. Is her appetite improving? Is she finished with the antibiotic?

Your vet is correct that anything under 68 on a pet meter is too low. If that happens you need to intervene with either high carb gravy food or by adding some Karo syrup or honey to her regular food. Most cats get very hungry when low. You can also use dry food but the other ways are better. You then need to keep testing every 20-30 minutes until above 68. It’s not safe to stop testing until over that for two hours once you stop feeding the food. If she goes low post here for help and add a question mark and write need help with low numbers. If someone helps you they will stay with you until it’s safe for you to stop testing. Read and print the information on handling low numbers on the yellow sticky just in case you post and nobody responds.

There’s lots to learn and it’s scary at first but you will get help here. Some cats regulate quickly and go off insulin. It took Max a year to stop bouncing and get tightly regulated but he had chronic pancreatitis for several years before becoming diabetic and his pancreas couldn’t recover on its own.

 

Did you give insulin the night of the 9th, the spreadsheet units is blank that night. Please put 0 if you deliberately skipped, so we know you didn’t just forget to enter a value.

If you did give insulin that night, you are on cycle 5 of that dose and those lows are due to the 0.5 units. The skips should have reduced the 1 unit depot. Since you are re going below 90 (much less 68) on the pet meter, you need to reduce the dose. Can you measure a 0.25 unit dose? There is a picture in the Sticky Note on fine dosing.

Regulation takes time. Insulin is a hormone, kitties need to learn how to work it. This is a marathon, not a sprint.

 

Any advice on how to get back to the normal 7am and 7pm schedule? Right now Mimi is on 10.15am 10.15pm schedule due to vet asking to skip dose and then asking to give shot after all...
I read that skipping is bad as she had high ketones at one point. Today her numbers are different again with a amps at +463 +6 at 271. She usually drops lower. Can I give her her shot earlier so we can try to get back to a reasonable schedule so I can go back to work eventually??

 

You can shoot 30 minutes early once a day or 15 minutes early each cycle.