Worried about low reading

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Patchy, Feb 16, 2020.

  1. Patchy

    Patchy New Member

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    Feb 16, 2020
    My cat just got diagnosed last week. He was in the hospital for 3 nights and released Friday night. They tried him on lantus first (I may have the name wrong) but his readings were uneven and they switched to caninsulin the night before release. He was supposed to be given 2 units twice a day. His appetite is not great. This morning I gave him his dose at a reading of 20.6 (sorry that’s what the alphatrak reads). Two hours later it was the same, 4 hours after initial it was 8.5, and just now at 6 hours after first dose of insulin it is 5.3. He has eaten today, not a huge amount as he is a grazer. Should I check him again? His last check was at 4:20 pm when he was 5.3. It’s now an hour later. He is sleeping, as he does that a lot. I gave him some temptations and chicken broth with some kibble in it
     
  2. JanetNJ

    JanetNJ Well-Known Member

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    5.3 is a good number but starting dose at 2 is a higher starting dose than we recommend. The recommended starting dose is 1 unit twice a day. Now with vetsulin 6 hours is probably his lowest (nadir for vetsulin is about 5-7 hours after the shot). If it were my cat starting tomorrow I would lower to 1 unit twice a day and continue to test. If not enough raise it in 0.25-0.5 increment.
     
  3. Patchy

    Patchy New Member

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    Thank you for the info, I’m reading as much as I can about all this, and it is all overwhelming. I’ll drop down the dose to 1 unit definitely for tomorrow. He’s scheduled to get his next dose at 10pm tonight. Should I skip it entirely, or would you know what reading would be the cutoff not to give it to him. What’s making this difficult is that he doesn’t eat a lot. He grazes and I’m also trying to transition from his old kibble to vet Purim’s dm wet food
     
  4. JanetNJ

    JanetNJ Well-Known Member

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    Are you using a human or pet meter? We usually recommend in the beginning not to shoot under 200 (about 11.1)
     
  5. Patchy

    Patchy New Member

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    I picked up the alphatrak 2 meter on Saturday. His dosage wasn’t figured out when he was released, and the first morning at home on Saturday he didn’t eat very much at 7am (his scheduled time) so it was delayed until 10am when I finally had a meter. So now I’m on a 10am to 10pm schedule.
     
  6. JanetNJ

    JanetNJ Well-Known Member

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    http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

    Have you read the guide to caninsulin? Also make sure to prepare in case he goes too low. It happens.

    When you get a chance please set up a signature. Click on your name at the top right corner and choose signature. Add info such as your pets name, date diagnosed, age, insulin type and meter. Also if there's any other medical problems other than diabetes.
     
  7. JanetNJ

    JanetNJ Well-Known Member

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    Ok so with a pet meter you might go a little more conservative and say no dose under 13... Just until you have more data. And no more temptations unless you need to raise bg. Those things are pure carbs.
     
  8. Patchy

    Patchy New Member

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    Thanks, I’ll do the signature soon. He’s an older stray we brought in 3 years ago. His diabetes was brought on by a 2 week course of prednisone.
     
  9. JanetNJ

    JanetNJ Well-Known Member

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    Ok so it's good you are home testing. It's quite possible he will go into remission. I know it's so scary and overwhelming at first. I promise as you learn more and get more comfortable it will all be routine. They can live long healthy lives with it. My cat was diagnosed in 2016.
     
  10. Patchy

    Patchy New Member

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    Feb 16, 2020
    I did the temptations as I was panicking that his reading was too low and could go lower. He has kidney disease as well which adds to the complexity of this all. I just need more guidance on how to adjust the insulin, when to worry with readings. They told me to get his meals to twice a day if possible, but he isn’t that type of cat. I’m curious what type of weruva do you use?
     
  11. JanetNJ

    JanetNJ Well-Known Member

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    Normal range on a pet meter it's around 3.8-8.3. I'd aim for around 5 to be the lowest just to keep safe. This is where you want the number to be at the lowest point. If it starts getting close to the bottom range then you can boost with food. If it's lower that's when you want to give gravy /honey, ect or if it's low /normal but with time to continue to drop.
     
    Last edited: Feb 16, 2020
  12. JanetNJ

    JanetNJ Well-Known Member

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    About feeding. Most of us find feeding several small meals works out better. Just try not to allow food at least 2 hours prior to the preshot test so the number is not food influenced.

    You asked what I'm feeding my ckd/diabetic. This is what she's eating now

    Weruva slide and serve pate foods Family Food (.97 phosphorus and 0 carb). Also Jeopurrdy Chicken (0.97 P 6.1 carb)

    Weruva Steak Frites (0.57 phosphorus 7.5 carb although I take out any big pieces of potatoes to try to limit the carbs just a bit)

    weruva Fowl Ball chicken and turkey (0.89 phosphorus 0 carb).

    Weruva LA isla Bonita - phosphorus 0.77 carb 4.5

    Weruva paw lickin chicken.

    Weruva let's make a meal
     
  13. Patchy

    Patchy New Member

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    Thank you so much Janet. You’ve been a great help. I’m seeing a local vet on Wednesday to come up with an actual plan rather than stumbling through all this
     
  14. JanetNJ

    JanetNJ Well-Known Member

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    No problem. Just remember you want food under 10 carb and under 1 percent phosphorus (for the kidneys). Don't let the new vet convince you to buy expensive perscription food. Just say you tried it and your cat refuses to eat it.

    Here's a link to our food chart


    https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
     
  15. Patchy

    Patchy New Member

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    Feb 16, 2020
    We walked out of the vet with all the prescription food and kibble. He’s not particularly a fan. Last night his last reading was 28.6. I contemplated giving him 1.5 but ended giving him 2 units again. I didn’t get that into him until past 11pm, so now how do I get him back on a normal schedule as I usually leave for work at 730? Right now, I’m taking days off to hopefully get this sorted out
     
  16. Patchy

    Patchy New Member

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    Feb 16, 2020
    His number this morning was 11.6. Afterwards I tried to get him to eat, but like usual he licked a bunch, mostly liquid and that was it. So I haven’t given him insulin yet. Or should I but drop the dose to 1 unit?
     
  17. JanetNJ

    JanetNJ Well-Known Member

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    2 units is a lot for a newly diagnosed cat. The recommended starting dose is 1 unit twice a day.
     
  18. JanetNJ

    JanetNJ Well-Known Member

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    If his numbers are high enough try moving the shot back a half hour each shot time to get back on track for when you're back at work.


    Try adding water to the food so it's nice and soupy.

    The perscription food is high in carb. Are you in Canada or the uk? There's a uk food list
     
  19. Patchy

    Patchy New Member

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    I’m in Canada. I’ve looked at the food charts, and am trying different brands that fit the low carb/lower phosphate grid. But he has always been picky. Do you think it’s too late to give him 1 unit now (1pm) for this morning, he was due at 11:20am? And should I check his blood again now?
     
  20. JanetNJ

    JanetNJ Well-Known Member

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    I would skip or your evening shots timing will be messed up now.
     
  21. Patchy

    Patchy New Member

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    Well everything is now messed up. I waited 2hrs from his 11.6, he had snacked a few times. So I thought I’d check and it was 34.5. I was worried how high it would go until 11:20 tonight, so gave him 2 units at 1:30pm. So now, I guess I’ll be up until early morning going through all this again. I’m trying to stick this out until Wednesday which is the earliest I can see a vet to get everything sorted out. Meanwhile, I’m off to the pet store to buy a few more tins of assorted food to find something he likes
     
  22. JanetNJ

    JanetNJ Well-Known Member

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    Not a big deal. You can move the time earlier tonight by up to an hour as long as he's high enough.
     
  23. JanetNJ

    JanetNJ Well-Known Member

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    Good job getting the spreadsheet going.
     
  24. Patchy

    Patchy New Member

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    Haha, thanks. Spreadsheet is a work in progress, but at least one small victory!
     
  25. Deb & Wink

    Deb & Wink Well-Known Member

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    Learning about how to treat feline diabetes can be intense at the beginning.
    Mindfulness Breathing can help to relieve some of the stress and anxiety.
    Deep breath, hold, release, clear you mind of all thoughts and concentrate on your breathing only.

    You're doing great so far and have already learned a lot from Janet.

    Please try to get some BG tests in during the PM dosing cycle.
    Right now, the only test you are doing in the evening cycle is the pre-shot test.
    Many people find that doing a test before they go to bed can be helpful. Cats are more active at night, so they often drop lower in their BG levels.

    You are super new to all of this, so probably didn't even think about the need to test in both 12 hour dosing cycles.

    Steroid induced diabetes can often resolve fairly quickly. Good insulin, lower carb food <10%, home testing. Those are the 3 basics of treatment.

    We'll see how Patches does on the Vetsulin/Caninsulin. Some cats are able to regulate on Vetsulin. Duration is often too short, only lasting 8-10 hours.

    There are better insulins for cats, like the lantus your vet rejected. Lantus has a depot effect, and it takes time to "fill the depot" and see the true results of that insulin. Prozinc is a good choice for cats also.
     
  26. Deb & Wink

    Deb & Wink Well-Known Member

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    Why was Patch in the hospital for 3 days? ketones? DKA? Something else?
     
  27. Patchy

    Patchy New Member

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    He was on prednisone for a couple of weeks. I noticed him losing weight, he was very lethargic. Took him to the local vet, he was somewhat dehydrated and his glucose level was high. He had never had that problem before. The vet suggested to take him to the overnight clinic as there is only one in town. He was there from last Tuesday night until Friday night. They had him on an I’ve drip to flush his kidneys as well. Keeping him there for any length of time is financially difficult (~$1K a day). They tried lantus for the first few days, but his levels never stabilized (likely too short a time frame), so they put him on caninsulin Thursday night and I picked him up Friday night. As you can tell from my posts, it’s been an adventure. I’m going to a different local vet tomorrow that only specializes in cats to put a plan in place. His minimal eating I find is the worst part as he has always only eaten small portions at a time. I think lantus is the way to go, but at this point his schedule is messed up
     
  28. Deb & Wink

    Deb & Wink Well-Known Member

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    Sounds from your description that Patch may have had DKA. Diabetic Ketoacidosis.
    Is that correct?

    I think lantus is the way to go also, but for now the caninsulin is the insulin you have to use.
    That shorter acting insulin is better for a cat that has recently had DKA.
    A cat that has DKA, needs to eat lots to keep the ketones away.
    They also need to keep hydrated.
    Do you have subq (subcutaneous) fluids to give at home?

    You might want to ask your vet about an appetite stimulant. Don't know if that is appropriate for a cat with CKD.
    What IRIS stage is the CKD (chronic kidney disease)?
    Stages are 1, 2, 3, 4.
     
  29. Patchy

    Patchy New Member

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    Feb 16, 2020
    If DKA is the same as a pH measurement (I recall the word acidosis), his measurement was normal for that as of release on Friday. For his kidneys, I don’t know the number, he had been low to mid, but last Tuesday he was high mid to low severe. I can’t recall the measurements. Hopefully it was because he wasn’t eating at the time and weight loss. Tomorrow morning I should have a better idea of where he is at. I’m now on a 1230am/pm insulin injection timeframe. I do a present about 30-60 min prior, then try and get him to eat. He is drinking, not as much as normal, but I’m also giving him mostly wet food. He’s always preferred kibble though, as he was on the royal canin vet kidney kibble for the past few years. I always would give him wet as well, but he just usually licks up the juice.
     
  30. Deb & Wink

    Deb & Wink Well-Known Member

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  31. Deb & Wink

    Deb & Wink Well-Known Member

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  32. Patchy

    Patchy New Member

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    No, it didn’t sound like many of those symptoms. He still drinks-not as much but probably due to more wet food, and grazes eating (not as much as previous though but as mentioned, I don’t think he cares for wet foods). He has never vomited or anything. He’s moving around, but not that zip in his step that he usually has. Just his glucose issue is the main one at this time. I get really confused when he hasn’t eaten a whole lot before his scheduled injection, and then depending what his preshot number is. Hopefully tomorrow the vet will give me a strategy to transition away from caninsulin to lantus as the latter seems to suit his grazing appetite better.
     
  33. Deb & Wink

    Deb & Wink Well-Known Member

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    Diabetic cats need to eat. In fact diabetic cats on Caninsulin/Vetsulin need to eat about 20 minutes before you give the insulin. That is so that the steep drop in blood glucose once the insulin is administered can be counteracted by the food being digested and getting into the bloodstream. They balance each other out.

    Caninsulin also can have a short duration. 8-10 hours. Doses of insulin are only given every 12 hours. For safety and because many people can not adjust there work/life responsibilities around dosing time adjustments to match the duration of the insulin in their cat.

    With Lantus, the sequence is test, feed, shoot all in 15 minutes or less.
    Lantus does not have such a steep drop as Caninsulin does. Better duration too.
     
  34. Deb & Wink

    Deb & Wink Well-Known Member

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    You might want to get copies of all the lab work, vet file notes printed out or emailed to you.
    My vet does that, and I keep them all in a folder for my cat.

    That way, I can refer back to them whenever I want.
     
  35. Deb & Wink

    Deb & Wink Well-Known Member

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    Any new BG readings to update Patch's spreadsheet (SS) with?
    Last entry was Monday morning, AMPS. 2/17/2020.
     
  36. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Hi and welcome to you and Patch.
    I would ring the vet who had Parch for a few nights and ask for a copy of the labs to be sent email to you and to ask if Patch tested positive to ketones at all. This is really important as it changes the way we approach his care for a few weeks. It is really important if he did have ketones that he eats plenty of food and he is getting enough insulin and fluids.
    When you go to the new vet I would ask them to test for ketones again and ask for some antinausea medications such as cerenia and ondansetron for you to give at home. They may give him an injection of cerenia.

    Also buy a bottle of Ketostix from a pharmacy and start testing for ketones at home. It is very important ketones are prevented from increasing if they show up. It is a simple urine test and not hard to do.
    Do you know if Patch had an infection when he was admitted?
     
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  37. Patchy

    Patchy New Member

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    Feb 16, 2020
    He had a slight bladder infection when he was in the overnight vet. They gave him a shot of covenia (sp?) for that. I will get all the paperwork tomorrow, and ask about ketones when I see the new vet tomorrow. I’ve been placing out so many different samples of food for him. He licks them all, then eats a few purina dm kibbles. Then he’ll sleep for awhile. He always did sleep a lot though. I have a few more readings, but these are pre-shot ones. I’m up until midnight or 1 am with his schedule now so there is no way I can stay awake for a curve overnight at this point.
     
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  38. Deb & Wink

    Deb & Wink Well-Known Member

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    We don't expect you to stay up at night to do a curve.
    Pick up the BG testing in the morning.

    Sleep well.

    Convenia is meant for skin infections, but some vets do use it off-label, for UTI's. (bladder infections)
     
  39. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    If they mentioned acidosis it probably was DKA so it is really important you do the things I mentioned above to prevent ketones reforming.
    Ask the vet to reckeck the urine as it’s very important that the urinary infection has been treated.
    DKA happens when there is not enough food, not enough insulin and an infection or inflammation in the cats body. Ketones form which can lead to DKA if not treated.

    If it was in fact DKA, then I would not worry about only feeding low carb at this point. ANY food is ok as long as Patch will eat it. The important thing is he eats and eats frequently.
    Also you don’t want to be skipping doses of insulin.
    If you can confirm with the vet he had DKA (or ketones) I think he would be better staying on caninsulin for a little while longer as he recovers. Lantus is a great insulin for cats and much better than caninsulin, but it takes time for the depot to fill with Lantus and we need to make sure Patch is getting the insulin he needs at this point. You can swap over to Lantus in a week or two when he is eating better and his BGs are more stable.
     
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  40. Patchy

    Patchy New Member

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    Feb 16, 2020
    Thanks everyone for the help. Yes at this time, I’m trying to keep him eating. I haven’t skipped any insulin doses so far. I’ll find out about DKA tomorrow. They’ll probably want to do current bloodwork so I’ll get a better picture how he’s doing.
     
  41. Deb & Wink

    Deb & Wink Well-Known Member

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    Sounds good keep us posted.
     
  42. JanetNJ

    JanetNJ Well-Known Member

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    Can you update the spreadsheet? Move the times back so you can get your schedule fixed

    You're doing good. Remember it is a marathon not a sprint
     
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  43. Deb & Wink

    Deb & Wink Well-Known Member

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    How are things going with Patch?
     
  44. Patchy

    Patchy New Member

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    I apologize for not updating things. A few weeks after my last post patch went into remission. I was so happy for a few days. But then found out his kidney levels had spiked and he is now stage 4. And in the past week they’ve continued to increase to extremely high levels. So since that time I’ve been trying to get weight back on him. He’s been stable at his diabetic weight (went up a little bit). But despite diet attempts and subcutaneous injections it seems I can’t stop the kidney decline. The poor guy can’t catch a break. And now most vet stores are closing as well. I wish I had better news
     
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  45. Deb & Wink

    Deb & Wink Well-Known Member

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    The diabetic remission is very good news. Sorry to hear that Patch's kidney disease has progressed to stage 4. Please, love him and comfort him as much as you can. :bighug:

    Most vets here in the USA will meet you at the curb or in the parking lot, have a staff member pick up your animal, doing any testing or exams as needed, and talk to you by phone throughout the exam. Perhaps the vets where you live are doing something similar.

    No worries on not getting back to us. I was simply reaching out, doing "touch backs", to see how folks were doing that we have not heard from in a while.
     
  46. Patchy

    Patchy New Member

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    Feb 16, 2020
    My local vet had implemented a closed door, distancing protocol when dropping a pet off. And had also had a policy of only dealing with sick pets. But now, even that risk is too high, so they are closing until things hopefully get better. We still have two 24hr vets in town, but even they are minimizing contact when dropping off animals. I’m just thinking of end of life scenarios and how awful it would be to hand my pet through a door without being with it.
     
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  47. Deb & Wink

    Deb & Wink Well-Known Member

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    I had not even thought of that dreadful possibility. Hope it does not come to pass.
     

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