Trying to understand BG numbers

ThisIsAllForZot

ThisIsAllForZot

Member
Zot started insulin a couple of days ago and was told to do a glucose curve 14 days after beginning insulin. I'm still learning, and I am wondering if I should continue stalling or skip his PM dose entirely tonight. Today was a difficult day for BG monitoring, and he was extra finicky, but a couple of hours ago, I found a groove with him, and the last 2 readings were very easy to get from him.

With him showing much improvement with the insulin over just the last couple of days, I am ecstatic but also a little concerned that he may end up dropping too low. @Bron and Sheba (GA) have been very helpful and told me that I could stall if below 200, wait to feed, and test again in 20 minutes and then post for help. I admit that I saw this a bit late, and when I sat down to check the forums, I had already given him his meal, but did not give the insulin. I still tested, and he read 186. I will test again soon to see how much it climbs, but I am searching for advice on what I should do or how I should handle this.

The vet has not taught me too much about BG levels or when/what to do apart from medical emergency-related things.
 
Here is your previous post for continuity
https://www.felinediabetes.com/FDMB/threads/introduction-need-advice.298659/#post-3249377

You can continue to use this thread for up to 50 posts. If needed you can change the subject line to reflect your issue.

I can see you skipped the pm dose which is ok.
In the morning if the Preshot is still low we will need to look at reducing the dose as you need a dose you can shoot both cycles.
I probably won’t be around when your am Preshot comes round as I live in Australia but I will ask @Bandit's Mom and @tiffmaxee to keep an eye out for you. You can tag them if you need advice as well.

Give Zot a couple of snacks this pm cycle and if you can get a test in that would be helpful.
Keep asking questions
 
Bron and Sheba (GA) said:
Here is your previous post for continuity
https://www.felinediabetes.com/FDMB/threads/introduction-need-advice.298659/#post-3249377

You can continue to use this thread for up to 50 posts. If needed you can change the subject line to reflect your issue.

I can see you skipped the pm dose which is ok.
In the morning if the Preshot is still low we will need to look at reducing the dose as you need a dose you can shoot both cycles.
I probably won’t be around when your am Preshot comes round as I live in Australia but I will ask @Bandit's Mom and @tiffmaxee to keep an eye out for you. You can tag them if you need advice as well.

Give Zot a couple of snacks this pm cycle and if you can get a test in that would be helpful.
Keep asking questions
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Just got another test from him; 162. It dropped again after I fed him his full meal earlier, which had originally bumped it up from 157 to 186, and now it is back down to 162. I also fed him a snack after this test. Will check him again soon at +6. Thanks so much for all of the help so far :)
 
I just want to confirm thee were no ketones at diagnosis. The vet should have told you if there were any.
It looks as if the 1 unit twice a day is going to be too much insulin.
The full potential of the dose is not going to be felt for 5 days …I think I would be inclined to reduce the dose to 0.5 unit twice a day and see how that goes…as long as the preshot is high enough to shoot.

And please let us know when you get a ketone test result.
 
Bron and Sheba (GA) said:
I just want to confirm thee were no ketones at diagnosis. The vet should have told you if there were any.
It looks as if the 1 unit twice a day is going to be too much insulin.
The full potential of the dose is not going to be felt for 5 days …I think I would be inclined to reduce the dose to 0.5 unit twice a day and see how that goes…as long as the preshot is high enough to shoot.

And please let us know when you get a ketone test result.
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October was when he had his full blood work up, but when he was diagnosed, only the glucose test was done.
Yes, I'm leaning more towards lowering his dosage if these numbers stay consistent. I'm glad it wasn't just me. I felt 305 to 157 was quite the drop for an injection overnight. Though I don't know what I'm doing yet entirely, I still have a hunch. It should be noted that with the drop from 305 to 157, I slept very heavily and did not wake to my alarms, so he missed out on one snack yesterday afternoon.

Should I speak to my vet before ultimately dropping his dosage? Or would this just be safe for me to try if his BG results come back under the 200 range before his AM dose? And should I still wait for it to reach over 200 to shoot in this case, even if I drop the dose to 0.5?

I will let everyone know when I get a ketone test result, yes :)
 
With SLGS, you have a couple of options if you are nervous about the pre-shot number being lower than where your comfort level is. However, keep in mind that the numbers you're seeing are great numbers and would not warrant reducing Zot's dose. His blood glucose reading would need to be below 90 for a reduction. The options with a low preshot include:
  • Stalling. This is what Bron had suggesting. Don't feed your cat. Wait around 20 min and re-test. Are numbers heading upward? Since your at the end of a cycle, you'd expect numbers to be on the rise.
  • Give a reduced dose. This is a one time reduction. However, you need to keep in mind that glargine is a depot-type of insulin. There is still insulin in the depot so that you need to keep an eye on Zot's numbers to be sure that the depot doesn't cause numbers to keep dropping.
  • Skip the shot.
There are pros and cons for each of these options. The other item to consider is that you want to be able to get to a point where you're comfortable shooting lower numbers. While it is completely counterintuitive, with glargine, shooting a lower number doesn't mean that your cat's numbers are going to drop like a brick. Often, you'll see a flat curve. In other words, the numbers stay in a normal/good range for the cycle.
 
Sienne and Gabby (GA) said:
With SLGS, you have a couple of options if you are nervous about the pre-shot number being lower than where your comfort level is. However, keep in mind that the numbers you're seeing are great numbers and would not warrant reducing Zot's dose. His blood glucose reading would need to be below 90 for a reduction. The options with a low preshot include:
  • Stalling. This is what Bron had suggesting. Don't feed your cat. Wait around 20 min and re-test. Are numbers heading upward? Since your at the end of a cycle, you'd expect numbers to be on the rise.
  • Give a reduced dose. This is a one time reduction. However, you need to keep in mind that glargine is a depot-type of insulin. There is still insulin in the depot so that you need to keep an eye on Zot's numbers to be sure that the depot doesn't cause numbers to keep dropping.
  • Skip the shot.
There are pros and cons for each of these options. The other item to consider is that you want to be able to get to a point where you're comfortable shooting lower numbers. While it is completely counterintuitive, with glargine, shooting a lower number doesn't mean that your cat's numbers are going to drop like a brick. Often, you'll see a flat curve. In other words, the numbers stay in a normal/good range for the cycle.
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I see. I skipped his PM shot last night, but it should probably be fine to shoot another dose with the numbers I've been seeing without much worry, so long as I monitor them closely. I guess I was just surprised by seeing that one dose help him as much as it did. But when reading 90s, would be when to consider an overall reduction in dosage?

Another question: How do ya'll sleep? It feels difficult to get a good rest while being concerned about monitoring numbers all the time. I'm trying, but oh, man.
 
You made me giggle!! Early in my time here when managing my cat's diabetes I commented, "Sleep is vastly overrated." That said, you will be collecting data on your cat's blood glucose and have a much better handle on what is typical for your cat. One of our popular comments is ECID -- every cat is different. So knowing how your kitty responds to insulin will help you to know when it's safe to go to sleep. We also strongly recommend getting a test every night before you go to bed. Between your PMPS and tests thereafter, you will know where numbers are heading.

You reduce the dose if numbers are below 90. If you have questions, given that this is still so new for you, please post and ask for help. You can edit your subject line (from your first post in a thread), to get eye on your post(s). There are usually people around 24/7.
 
Sienne and Gabby (GA) said:
You made me giggle!! Early in my time here when managing my cat's diabetes I commented, "Sleep is vastly overrated." That said, you will be collecting data on your cat's blood glucose and have a much better handle on what is typical for your cat. One of our popular comments is ECID -- every cat is different. So knowing how your kitty responds to insulin will help you to know when it's safe to go to sleep. We also strongly recommend getting a test every night before you go to bed. Between your PMPS and tests thereafter, you will know where numbers are heading.

You reduce the dose if the numbers are below 90. If you have questions, given that this is still so new for you, please post and ask for help. You can edit your subject line (from your first post in a thread), to get eye on your post(s). There are usually people around 24/7.
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Thank you so much :), and yes, sleep has been quite an almost stressful thing so far. I tested him before I took a nap today as well, to be safe.
I did also try calling the vet just to discuss the numbers to make sure, but she wasn't in the office, so they couldn't give me an answer. Still a little confused about what to do; his numbers have climbed since last night on his AMPS. I just don't know how he functions yet. I have Karo syrup and a little bit of higher-carb wet food just in case. He has eaten his meal and is in preparation for his dose.

I'm wondering if it would be better to do the one-time reduction you were talking about to make sure, since I don't know him well yet. I wish there was a direct rule book for this right about now lol.

Edit: Saw @Diane Tyler's Mom GA comment on my other post, I will give him the 1 unit and monitor him closely <3 This is all so stressful, or maybe I'm just super high anxiety lol.
@Diane Tyler's Mom GA @Bron and Sheba (GA) @Sienne and Gabby (GA)
 
A rule book would definitely help but then again, Zot is a cat. Being predictable is just not in their nature!

A couple of bits of information. The difference between your PM +9 test and your AMPS is negligible. There is a variance of about +20% with any number you get. This is due to the measurement error inherent in a meter and/or strip. The 169 from last night and the 182 from this morning are pretty much the same number.

When a cat drops into low numbers, into numbers lower than what he's used to, or the drop in numbers is fast, there's a high likelihood that you'll see what we refer to as a "bounce." When this happens, numbers spike upward as a result of the liver and pancreas releasing a stored form of glucose along with counterregulatory hormones. It can take up to a few days for the bounce to clear.

Also, one of the things that I found most helpful about FDMB was that people -- knowledgeable people -- are usually around when you need help. Vets are not around 24/7 and it would cost a fortune to take your cat to an emergency clinic if you simply had a question. We would tell you to get to an ER if your cat was in a dangerous situation (or I know I would do that as would experienced members). Everyone is anxious at the beginning. As you learn more, you'll become increasingly confident.
 
I haven't been on since yesterday, so I'm still catching up on all the replies between both posts.

Talked to the vet yesterday, and they said they'd probably consider dropping the dose if he drops to the 90-100 range this early on. She told me to give him more calories as well, just in case.
I've been giving the 1-unit doses, and I have been giving him bigger snacks. He had his last snack at around +6, and the numbers are still consistently dropping despite this. He also sneaked a bit of extra food when I stepped out of the room to grab a washcloth, so he probably had a slightly bigger meal at his PMPS than usual because of this. I don't know if this will end up being a bounce or not as @Sienne and Gabby (GA) mentioned can happen, or if it's just a variance sort of situation, but I am currently stalling and testing again in 20 minutes to see if his numbers start climbing again.

My question is, if they do not start climbing, what is the best option for me to take with Zot? Or, more importantly, if they have dropped more despite him being at the end of the PM cycle?

Also, good news! For those people who know about his constipation or pooping problem, he finally went after 3ish days! Still gonna keep a close eye on that for the next week or so.

Just tagging some people who may be able to answer my questions before I get his next BG reading, once again I appreciate everyone being so supportive: @Bron and Sheba (GA) , @Diane Tyler's Mom GA , @Bandit's Mom @tiffmaxee . Everyone has been so kind and supportive through this confusing and new diagnosis! :)

Also, still working on getting a urine test, but since he's been on insulin, he has been urinating a lot less. Also keeping an eye on this, though he seems well-hydrated despite this.
 
tiffmaxee said:
Looks like he’s too low to give insulin . Did you last test 25 minutes after first test? Did you test again ? Did you feed ?
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I did not feed. But I tested again, and he had gone from 108-106 in 25 minutes instead with the stall.
I also have sent the vet an email, as he has been eating more this last cycle, and additionally, being at the end of his pm cycle, I feel as though there should be some rise judging from everything I've learned here so far.

I have still not fed him yet, as I'm not sure what the right decision is for him right now.
 
Tested again, another 20 minutes later, 108, so slightly higher than the previous reading 20 minutes ago, but only slightly.

EDIT: He's pretty hungry. Unsure if I should just feed him his main meal or stall for a bit longer. Should I have been seeing increases in his BG when testing on his PM cycle, considering he was eating more than on previous days?

Also note that I did indeed see BG increases after/around snack times a couple of hours after on previous days. So I am confused.
 
I would feed and skip the dose. See where he is at his next shot time. 1.0 might have been too high a starting dose. The depot has not even filled yet.
 
tiffmaxee said:
I would feed and skip the dose. See where he is at his next shot time. 1.0 might have been too high a starting dose. The depot has not even filled yet.
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He's currently eating his meal, and I will skip the dose.

Also earlier, I mentioned that he has pooped for the first time since the 25th, but there was one concern. Going to speak to the vet's office about it too. I just don't know if it's common in diabetic cats, or maybe his diet change to all wet food. The 2 poops he has had on the 26th and today have been very dark, more similar to black. Which I fear is some sort of bleeding-related issue. Though, even if it is, I wonder if it is related to his recent abscess popping a few days prior to his diagnosis on the 25th. I am discussing again with the vet, as the combination of his unusual pooping, and lack of is concerning.

Just wondering if this is a common issue when switching diets, or in specific, diabetic cats?
 
Is he drinking enough? Your vet could check for blood in the stool. My cats’ stool color changes depending on what protein they eat. Friskies is an affordable but not quality food. Many feed it as it’s low carb. Have you tried miralax? Max usually was not constipated but ur would happen when he had to get ondansetron fur pancreatitis. Wet food should not cause constipation I would think. FD might if dehydrated. I add a little water to all food.
 
tiffmaxee said:
Is he drinking enough? Your vet could check for blood in the stool. My cats’ stool color changes depending on what protein they eat. Friskies is an affordable but not quality food. Many feed it as it’s low carb. Have you tried miralax? Max usually was not constipated but ur would happen when he had to get ondansetron fur pancreatitis. Wet food should not cause constipation I would think. FD might if dehydrated. I add a little water to all food.
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He is drinking quite a lot and urinating frequently, but not as much as before with untreated diabetes. Yes, he has started Miralax today. I'll add some extra water to his wet food from now on to see if I see improvement and help with hydration.
Spoke to the vet office and it does seem possible that he had some blood that he swallowed from the abscess, or even the current open wound over the last couple of weeks, (His cone does not prevent him from sticking his tongue in his wound), though it has scabbed over within the last 2-3 days. They're going to reach back out today after they speak to the Vet who performed the abscess flush- and also notify the Vet who is currently treating his diabetes of the concerns with his numbers. Hopefully, I will hear back before they close today.

I don't understand ketones yet, but he has not been tested for them. Still trying to get that urine sample, but his urination habits seem random. Finally, the other night when I was lying in bed, just barely fallen asleep. I heard him starting to go, but could not make it in time in my overly-exhausted, sleep-like state. If there were ketones present, could this be affecting his potty time problems? I also would not expect wet food to be giving him constipation troubles. His behaviors are normal and he is not struggling to use the bathroom, but he just... doesn't seem to have to go #2?
 
tiffmaxee said:
There’s a really good site on feline constipation. The owner who was so helpful on cat sites sadly passed away but I checked and it’s still there. https://felineconstipation.org/prevention.html
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Thank you so much for this resource. I am sorry to hear about the owner. :(

Also, an important update. It had been 2 hours since he had his last meal. He had a pretty large meal, with 2 tablespoons extra. I just tested his BG, and it is still dropping and at 98... I am running to the store because I want the highest carb wet food I can get, just in case. Heading out right now (It's like 5 minutes away max, so should be okay). Is this a really bad situation? Should be home in like 10 minutes max.

EDIT: On the phone with the vet right now.
 
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No. It’s not a bad situation because he did not get any insulin this morning. Normal BG for a cst in a human meter is 50-100 or 120. Many cats that are not diabetic get into the 40’s. You don’t want to give high carbs or sugar if he’s not had any insulinHow was it determined he’s diabetic? Did the vet run a fructosamine? Either he’s not diabetic or the original dose was too high. What was he eating before the food change ? A diet change can also get a cat o to remission. I’m goin g to read through your prior threads but wanted to comment first.
 
Keep in mind that if you don't give your cat a shot, there may be a bit of insulin from the depot that's having an effect on numbers but the likelihood that your cat will drop into hypoglycemic numbers is unlikely. If the pancreas is working (or healing), food stimulates it to produce its naturally occurring insulin. And again, the difference between your AMPS and +4 is minimal. They are essentially the same number.
 
tiffmaxee said:
No. It’s not a bad situation because he did not get any insulin this morning. Normal BG for a cst in a human meter is 50-100 or 120. Many cats that are not diabetic get into the 40’s. You don’t want to give high carbs or sugar if he’s not had any insulinHow was it determined he’s diabetic? Did the vet run a fructosamine? Either he’s not diabetic or the original dose was too high. What was he eating before the food change ? A diet change can also get a cat o to remission. I’m goin g to read through your prior threads but wanted to comment first.
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I see. So the reason he was diagnosed as diabetic, was back in October when he had a blood workup for a precautionary sort of thing due to his age before surgery he was reading over 500mg/dL at the veterinary office.
Last time I went in, they only did the glucose test as money was tight and they wanted to make sure we could get the abscess flushed but also afford to see his sugars. His sugars were over 300 mg/dL this time as well.
He was being free-fed friskies dry food, and habitually walked back and forth, ate a little bit, waited, ate a little bit, waited. He ended up gaining weight up to 15lbs. Since October he has lost 2-3, despite eating the same amount, so this information in combination with the glucose tests is why they diagnosed him as a diabetic.

I spoke to my vet, and she is a bit confused by the situation but she calmed me down and wants to take him off insulin for a week. She has told me it is a mysterious case due to previous numbers that are typically not seen in stress-spikes.
She said there's a few things she could think of that could be happening here.

He is either not insulin-dependent or not diabetic and somehow was just having a crazy stress reaction to vet visits.
Or he has already gone into a very young remission.
Or he's just a different type of case that will need some more effort.
So she wants me to take him off insulin for a week and keep monitoring his BG before meals.
 
Sienne and Gabby (GA) said:
Keep in mind that if you don't give your cat a shot, there may be a bit of insulin from the depot that's having an effect on numbers but the likelihood that your cat will drop into hypoglycemic numbers is unlikely. If the pancreas is working (or healing), food stimulates it to produce its naturally occurring insulin. And again, the difference between your AMPS and +4 is minimal. They are essentially the same number.
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Right, I forgot about this. So much to remember and take into account. I'll do my best to continue to keep this in mind.
 
I’d keep testing. When I saw my vet fur a spot check and Max had a low nadir and my vet thought he was in remission. I wasn’t testing at home at the time. I think I went back a month later and he had to go back on insulin. I’m not saying this will happen with your cat but just keep testing at least morning and night. Hopefully he quickly became diet controlled. The infection he had provably spiked his BG at diagnosis along with stress from the vet visit as well .
 
tiffmaxee said:
I’d keep testing. When I saw my vet fur a spot check and Max had a low nadir and my vet thought he was in remission. I wasn’t testing at home at the time. I think I went back a month later and he had to go back on insulin. I’m not saying this will happen with your cat but just keep testing at least morning and night. Hopefully he quickly became diet controlled. The infection he had provably spiked his BG at diagnosis along with stress from the vet visit as well .
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I will keep this in mind and be very careful. I am going to test before every meal and before I go to sleep, as was suggested, to feel safer about it. I will keep his behavior in mind, too. So far, he is doing great, I don't know why I was so panicked earlier.
If I'm being so honest right now. I've hardly slept, and I think it's affecting my anxiety levels greatly. I'm doing my best to stay calm and collected, but so far, it's way easier said than done.

I think I'm going to try and take a more reasonable amount of time for myself to sleep instead of being super hyperfixated on numbers and setting alarms to wake up every single night to try and monitor him (I don't mind doing this most nights, but some nights I need sleep so that I can take better care of him). If I don't, I feel that I'll stay hyperfixated, panicked, and overthinking.

Oh, I forgot to mention, he did also have the clinical symptoms, frequent urination and larger urination masses. The biggest is 2x the size of my entire hand, which I am still honestly perplexed by. He was urinating quite a lot as well, so this played a part in his diagnosis.

At this point, I don't really know what's going on, but regardless, I always appreciate the help through my anxiety and sleep-deprived, delirious overthinking haha. And I will keep doing my best to learn (and remember) all the advice, links and information everyone is sending me. I know I've said it a few times, but it's been really comforting and amazing to have a community like this.
 
I disagree with your vet. I really wonder how many diabetic cats she's treated. To be honest, Zot's presentation doesn't seem in the least bit odd to me. I've been around here a long time and given the number of diabetic cats we see, I suspect my baseline and the baseline of the other long time members is vastly different than that of most vets. We do diabetes all day all the time!!

I suspect the abscess may have initially triggered the diabetes. Any sort of inflammation or infection is a stress on the system which causes stress hormones (corticosteroids) to be released. The presence of steroids can trigger diabetes. We've seen any number of cats who have a medical condition for which steroids are a legit form of treatment. They can become diabetic. Even something like a cat needing a dental because they have gingivitis is a big reason that a cat that has gone into remission relapses back into diabetic numbers. So, the infection may have been a reason for the diabetes. Zot is still in diabetic numbers. There are risks associated with leaving your cat in a higher than normal range without any, or at least limited, support for his pancreas. A big risk is diabetic ketoacidosis (DKA) especially if Zot still needs a dental or if the abscess hasn't fully cleared up. (DKA is caused by the presence of an infection/inflammation + not enough calories + not enough insulin.)

When a cat is doing well and getting closer to remission, we gradually reduce the amount of insulin. This is a spreadsheet of a cat that is a few days away from remission to give you a feel for what we do and what the spreadsheet looks like. Pasha was diagnosed about 15 months ago. By gradually reducing the dose, you provide support for a pancreas that's in the process of healing. If you stop the insulin prematurely, the pancreas can't produce enough endogenous insulin to offset the influence of food and your cat is back in diabetic numbers.

That's my 2 cents. I understand if you plan to follow your vet's advice. I'd suggest asking your vet what she considers normal blood glucose values.
 
Sienne and Gabby (GA) said:
I disagree with your vet. I really wonder how many diabetic cats she's treated. To be honest, Zot's presentation doesn't seem in the least bit odd to me. I've been around here a long time and given the number of diabetic cats we see, I suspect my baseline and the baseline of the other long time members is vastly different than that of most vets. We do diabetes all day all the time!!

I suspect the abscess may have initially triggered the diabetes. Any sort of inflammation or infection is a stress on the system which causes stress hormones (corticosteroids) to be released. The presence of steroids can trigger diabetes. We've seen any number of cats who have a medical condition for which steroids are a legit form of treatment. They can become diabetic. Even something like a cat needing a dental because they have gingivitis is a big reason that a cat that has gone into remission relapses back into diabetic numbers. So, the infection may have been a reason for the diabetes. Zot is still in diabetic numbers. There are risks associated with leaving your cat in a higher than normal range without any, or at least limited, support for his pancreas. A big risk is diabetic ketoacidosis (DKA) especially if Zot still needs a dental or if the abscess hasn't fully cleared up. (DKA is caused by the presence of an infection/inflammation + not enough calories + not enough insulin.)

When a cat is doing well and getting closer to remission, we gradually reduce the amount of insulin. This is a spreadsheet of a cat that is a few days away from remission to give you a feel for what we do and what the spreadsheet looks like. Pasha was diagnosed about 15 months ago. By gradually reducing the dose, you provide support for a pancreas that's in the process of healing. If you stop the insulin prematurely, the pancreas can't produce enough endogenous insulin to offset the influence of food and your cat is back in diabetic numbers.

That's my 2 cents. I understand if you plan to follow your vet's advice. I'd suggest asking your vet what she considers normal blood glucose values.
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I see; this all makes a lot of sense. I am honestly not sure what to do, I will do a test again soon, and then an AMPS before his usual dose, and if the numbers keep climbing high, I will dose regardless of everything if they are still going up. The vet has access to view his spreadsheet as well, but I'm wondering if she maybe doesn't know that he's being monitored with a human meter. I am going to send an email and label it as a human meter on the spreadsheet just to make sure, as maybe she is reading these numbers with a pet meter like Alphatrak in mind?

Ultimately, I just want to do what's best for him. Still working on getting the urine sample, he's just been urinating so much less, so I'm going to try some less absorbent litter I picked up at the store today.

Also, been trying 100% pure coconut oil on his ears since they look a little sore, and so far he thinks its just a yummy treat and doesn't waste any time licking it off immediately and trying to break into the jar.

EDIT: She told me that I should be more concerned if his levels hit 50, or closer to 400-500. So I imagine anything that she feels are normal and safe to some degree.
 
I suspect from the perspective of a vet, they worry A LOT about low numbers and understandably so. Part of the difference is that many vets do little to promote home testing and some will actively advise caregivers that their cat will hate them if they home test. As a result, vets will tread very carefully to avoid your cat being in low (i.e., normal) numbers since if you're not home testing, you and the vet have zero way of knowing just how low the numbers have gotten. All they can go by are fructosamine tests which are an average over several weeks. Often, what I advise members to discuss with their vet is would the vet not test their human infant child if the child was diabetic? I would guarantee that a parent would test to ensure their child was in safe numbers regardless of whether those were low or high readings.

We would also encourage you to steer the numbers with food if they were dropping. Generally, if you're getting tests that indicate numbers are heading downhill, try some of Zot's regular, low carb food and then re-test in 20 or so minutes. Has the drop slowed down or are numbers going up? If they are still dropping and your radar is going off, try some high carb and repeat the process.

My philosophy is to let the numbers guide your decision making. You're at home with your cat and know your cat far better than the vet -- or us, for that matter.

Just an FYI - if you start skipping shots, you'll lose the benefit of a long acting insulin like glargine. We can always adjust a dose.
 
Sienne and Gabby (GA) said:
I suspect from the perspective of a vet, they worry A LOT about low numbers and understandably so. Part of the difference is that many vets do little to promote home testing and some will actively advise caregivers that their cat will hate them if they home test. As a result, vets will tread very carefully to avoid your cat being in low (i.e., normal) numbers since if you're not home testing, you and the vet have zero way of knowing just how low the numbers have gotten. All they can go by are fructosamine tests which are an average over several weeks. Often, what I advise members to discuss with their vet is would the vet not test their human infant child if the child was diabetic? I would guarantee that a parent would test to ensure their child was in safe numbers regardless of whether those were low or high readings.

We would also encourage you to steer the numbers with food if they were dropping. Generally, if you're getting tests that indicate numbers are heading downhill, try some of Zot's regular, low carb food and then re-test in 20 or so minutes. Has the drop slowed down or are numbers going up? If they are still dropping and your radar is going off, try some high carb and repeat the process.

My philosophy is to let the numbers guide your decision making. You're at home with your cat and know your cat far better than the vet -- or us, for that matter.

Just an FYI - if you start skipping shots, you'll lose the benefit of a long acting insulin like glargine. We can always adjust a dose.
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I understand I will not skip any more doses unless necessary.

Through all of this he has been completely unbothered, happy and has shown no true negative signs in anything physical.

I will probably choose to give the dose at his usual AM time, as this seems like the smarter decision at the moment.

EDIT: I also will practice being calmer and more collected so I can make reasonable decisions, and reach out when needed but not in a panic, as I think this is hurting more than it's helping
 
Update: I will give him his dose today and keep monitoring him. I will try to do some more research and read through some more forums to better understand his BG readings on my meter and how they function. I will not panic. I will watch his behavior in combination with his BG, instead of just his BG.
He is in a good mood today, still not pooping much though.
He is starting to sit a little bit better for BG pokes.
His appetite is good, he finished his meal.
He's drinking normally.
Urinating a little bit less than usual since early last night, around 11 hours ago.
Still looking for a chance to get a ketone test result.
Will test him again at +2 this morning.
 
Please -- reach out whenever you need or want to. We are/were all anxious at the beginning of learning how to manage our cat's diabetes. We've had vet's who were here as members and they were nervous because it's their cat -- not someone else's. It the same with all sorts of medical professionals and even human diabetics. If this is you being in a panic, you're doing great. We have many people where their anxiety seeps through the computer screen!
 
Sienne and Gabby (GA) said:
Please -- reach out whenever you need or want to. We are/were all anxious at the beginning of learning how to manage our cat's diabetes. We've had vet's who were here as members and they were nervous because it's their cat -- not someone else's. It the same with all sorts of medical professionals and even human diabetics. If this is you being in a panic, you're doing great. We have many people where their anxiety seeps through the computer screen!
Click to expand...

I have been so panicked, but I've been trying really hard not to be! I appreciate this. I keep repeating that he's happy, he's alert, he isn't showing signs of pain or serious symptoms, and most of all, he's getting the treatment he needs, and the numbers are only scary because I'm still trying to figure out what I'm doing lol.
It would mean a great deal to me if I could ask you to check in on his chart to make sure I'm doing things okay sometimes. At least maybe while I learn to navigate this? <3 Of course, only if you find a moment of time to do so, I know you are helping many others with their questions and situations :)
 
Hey Stephanie, there are blood ketone meters if you continue to struggle with catching him in the litter box. It’s like checking BG but ketones instead.

You mentioned some bowel movement issues. This is not required and maybe is a little crazy, but we keep a count of urinations and bowel movements in the comments of the spreadsheet. I feel like it’s good to have a baseline, and if anything changes you have that historical info rather than trying to remember.
 
Tim & Pookey said:
Hey Stephanie, there are blood ketone meters if you continue to struggle with catching him in the litter box. It’s like checking BG but ketones instead.

You mentioned some bowel movement issues. This is not required and maybe is a little crazy, but we keep a count of urinations and bowel movements in the comments of the spreadsheet. I feel like it’s good to have a baseline, and if anything changes you have that historical info rather than trying to remember.
Click to expand...

I will start logging this, thank you!
I will look into a blood ketone meter and keep it on my list, just in case I cannot! But this also seems like it may be more consistent than trying to catch him for urine tests. Is there any difference in reliability in using either of these? I imagine that it's pretty valuable to be able to get a ketone reading in a pinch.
 
ThisIsAllForZot said:
I will start logging this, thank you!
I will look into a blood ketone meter and keep it on my list, just in case I cannot! But this also seems like it may be more consistent than trying to catch him for urine tests. Is there any difference in reliability in using either of these? I imagine that it's pretty valuable to be able to get a ketone reading in a pinch.
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Both methods for testing ketones are legitimate, ketones show up sooner in the blood compared to the urine though. The meters and strips are pricier than the regular urine strips, so I think that’s why you see a lot of folks do the urine.
 
Tim & Pookey said:
Both methods for testing ketones are legitimate, ketones show up sooner in the blood compared to the urine though. The meters and strips are pricier than the regular urine strips, so I think that’s why you see a lot of folks do the urine.
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That is fair. May I ask how frequently urine is usually tested for ketones in a diabetic pet? Is it occasional or just when there are infections, unusual behavior, or inflammation present? I may have been told or read this elsewhere on the forum, but I do not recall. I sometimes need 5-7 business days to process information, and there's a lot of it on here, LOL!
 
ThisIsAllForZot said:
That is fair. May I ask how frequently urine is usually tested for ketones in a diabetic pet? Is it occasional or just when there are infections, unusual behavior, or inflammation present? I may have been told or read this elsewhere on the forum, but I do not recall. I sometimes need 5-7 business days to process information, and there's a lot of it on here, LOL!
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Haha, I can relate to that. That’s what I would do.
 
It's fine to reach out to me. The best way to get me during the week is to send a PM. There are times when I'm completely swamped at work and I don't get to the board, sometimes for a couple of days. A PM will reach me.

Bron is an experienced member and very familiar with Lantus. She's in Australia so is around when the rest of us are sleeping.

If Zot never had a problem with ketones, unless he's sick, the chances are low that they will develop. It's good to check every so often. Since he needs a dental, I would check once or twice a week.
 
Sienne and Gabby (GA) said:
It's fine to reach out to me. The best way to get me during the week is to send a PM. There are times when I'm completely swamped at work and I don't get to the board, sometimes for a couple of days. A PM will reach me.

Bron is an experienced member and very familiar with Lantus. She's in Australia so is around when the rest of us are sleeping.

If Zot never had a problem with ketones, unless he's sick, the chances are low that they will develop. It's good to check every so often. Since he needs a dental, I would check once or twice a week.
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Got it. If I cannot manage a urine test in the next 2 days, I will purchase one of those fancy ketone devices.
Thank you again. :)
 
ThisIsAllForZot said:
I will look into a blood ketone meter and keep it on my list, just in case I cannot! But this also seems like it may be more consistent than trying to catch him for urine tests. Is there any difference in reliability in using either of these?
Click to expand...
"The three main ketone bodies are acetoacetate, beta-hydroxybutyrate (BHB), and acetone. In dogs and cats with DKA, BHB is the predominant ketone body, making it a key player in the diagnosis of this condition (Durocher et al., JAVMA 2008)."

"...urine dipsticks may not always reliably detect it (Di Tommaso et al., JVIM 2009). This is because dipstick tests primarily measure acetoacetate and, to a lesser extent, acetone, but not BHB."

From: https://vetemcrit.com/ketone-detection/
 
Staying calm and collected this time.

I decided to go through with his dose as I felt that maybe I was overreacting. He had 1U, his AMPS read 221, @+2 he dropped to 123, @+3 he is reading 77 now. Just wanted to check in and make sure that this isn't concerning without panicking and stopping his insulin as I did the entirety of yesterday.
I am monitoring, fed him a snack of his LC wet food and will test again in 20 minutes.
 
The test strips for the blood ketone meter are about $1 a strip. You mostly only need to use them occasionally, but they come in mighty handy if he is acting off one day.
I am EST and you are PST I think, so I don't know what + number you are at right now, but I would get another BG test soon.
 
Dyana said:
The test strips for the blood ketone meter are about $1 a strip. You mostly only need to use them occasionally, but they come in mighty handy if he is acting off one day.
I am EST and you are PST I think, so I don't know what + number you are at right now, but I would get another BG test soon.
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Yes. A blood ketone meter might be a good investment for us.

I am testing him again in about 15ish minutes or so and keeping a close eye on his behavior. I did just wake him up from a nap to poke him, so he wasn't the most energetic, but will also monitor his behavior.
 
What I'm seeing is that Zot may be responding to insulin a littler earlier than is typical -- in other words, an early onset. My cat typically had an early onset and early nadir. Some of the reaction could also be a result of no insulin last night and he's responding to the shot today. There may be a couple of other factors to consider. If the infection is clearing out of his system, you'll see better numbers. If his pancreas is healing, you're getting a response to food -- his pancreas is producing endogenous insulin.

I tend to be a bit of a testaholic. I would get a test at +3.5. You can either give more low carb food to flatten things out or if he's dropping, a teaspoon or two of higher carb is fine. This is a post on handling low numbers. It's helpful to either bookmark it or print out a copy.

This timeline may be helpful so you have a picture of what a "typical" Lantus cycle looks like:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir/Biosimilars: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.
Click to expand...
Insulin onset is at around +2. Nadir (lowest point in the cycle) is mid-cycle. None of this is written in stone. Some cats have an earlier response; some cats have a later response; and some cats follow the rule book. And, just when you think you understand how your cat responds, everything changes.
 
Sienne and Gabby (GA) said:
What I'm seeing is that Zot may be responding to insulin a littler earlier than is typical -- in other words, an early onset. My cat typically had an early onset and early nadir. Some of the reaction could also be a result of no insulin last night and he's responding to the shot today. There may be a couple of other factors to consider. If the infection is clearing out of his system, you'll see better numbers. If his pancreas is healing, you're getting a response to food -- his pancreas is producing endogenous insulin.

I tend to be a bit of a testaholic. I would get a test at +3.5. You can either give more low carb food to flatten things out or if he's dropping, a teaspoon or two of higher carb is fine. This is a post on handling low numbers. It's helpful to either bookmark it or print out a copy.

This timeline may be helpful so you have a picture of what a "typical" Lantus cycle looks like:

Insulin onset is at around +2. Nadir (lowest point in the cycle) is mid-cycle. None of this is written in stone. Some cats have an earlier response; some cats have a later response; and some cats follow the rule book. And, just when you think you understand how your cat responds, everything changes.
Click to expand...

So many complexities. This information is so valuable. I did see the sticky earlier for handling low numbers. I have really bad untreated severe ADHD and I feel that is why I'm scattered and forgetful a lot of times. I have no printer, but I will make an animated wallpaper that has all this important information for my desktop with wallpaper engine. Thank you, again. :)

I believe that while he is still healing from an abscess, when he was last checked (and also diagnosed a diabetic), they had told me that, surprisingly, there was no infection that they could see, and he wasn't running a temperature. I was a little concerned about a very active infection popping up from the open wound he could reach with his cone on (on his right cheek), but it has since scabbed over and looks much better. I am wondering if the infection cleared up due to the initial precautionary antibiotic injection (when his face started swelling and when he was running a temp) in combination with the abscess flush a few days later. Nonethless, he still needs dental done and he is still finishing healing up the big hole on his face, so I'd imagine this would s till affect it to some degree regardless. There was probably an infection present the first couple of days the abscess was active.

He thrashed again while I was testing him too. I'm having trouble holding his head gently but firm because of the wound on his face. I do not want to push into it or rub it hard when he moves around. He has a little tear now in his ear because of this. I feel so bad about it, and he's definitely not happy with me right now. He is still doing a lot better sitting pretty for his pokey time though.

I just want to confirm: His BG did drop below 90. Does this warrant a 0.25 reduction in dose? If so, how do ya'll see the dosage? I know there are half-unit markings; I already struggle to see those WITH distinct markings.
 
Hi Stephanie
It is great you are asking lots of questions. We are always happy to answer them.
Yes you are correct. If Zot is doing SLGS he has earned a reduction in dose down to 0.75 unit.
To get the 0.75 unit you need to draw the insulin up to half way between the 1/2 unit and 1 unit mark.
Make sure you have in a good light and I used a magnifying glass to check those inbetween doses.
 
Bron and Sheba (GA) said:
Hi Stephanie
It is great you are asking lots of questions. We are always happy to answer them.
Yes you are correct. If Zot is doing SLGS he has earned a reduction in dose down to 0.75 unit.
To get the 0.75 unit you need to draw the insulin up to half way between the 1/2 unit and 1 unit mark.
Make sure you have in a good light and I used a magnifying glass to check those inbetween doses.
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You all are super-human. I will be as accurate as humanly possible, my anxiety could not handle anything less than accurate! I imagine even with this for beginners/SLGS, they still stall if reading under 200 despite the dose change, right?
 
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