questions about testing BG levels and lantus pen....

Hi, Spike and I are new to this.
1) he's been getting Lantus, 2 units 2 times a day, since March 15th 2016. I sometimes leave out a little tiny amount of Purina Dry D/M food for Spike because he was a grazer. I have him on low carb wet food (Purina D/M and Fancy Feast Classic), two times a day, but again b/c he was a grazer all of his life, I do leave a little D/M dry out during the day. BUT, when I test Spike's BG levels, I don't know how recently he ate that dry food. So, him eating his dry D/M food, will that affect his blood glucose level? I still don't fully understand how diabetes and the insulin work, as far as do cat's BG levels increase after they eat? or decrease after they eat?

So, should I be making sure he hasn't eaten at least 2 hours before I test his BG levels?

2) should I be gently shaking his Lantus pen to mix the insulin before I give him his shot?

3) I just watched the lantus video and it says not to put any of the insulin back into the pen from the syringe, I have done this, not knowing that I should not do that, is this a major problem? also, I did get an air bubble into the lantus pen, is this a major issue too?

Thanks, Mary and Spike

 

Hi Mary!

In regards to your question about dry D/M, it has about 18% carbs and definitely will increase his BG level. We had our boy on it and once we stopped feeding him that, his BG levels dropped quite a bit. He was on 5.0 units of Lantus twice daily and now he is on 3.5 units twice daily. If you do stop feeding it, please make sure you are home testing though as you may need to make adjustments to his dosage. Also, yes you do need to pick up all food two hours before both pre shot tests.

I'll let others weigh in on the pen as we are still using the vial we got when he was diagnosed.

Good luck with everything and welcome!

 

oh wow, I didn't realize the dry d/m is so high in carbs! I will decrease slowly and check his levels at home as much as I can. thanks.

 

It can make a big difference so please just be very careful if doing it and you really have to be on top of the home testing. It is very, very important. There are more experienced people here that can chime in and help with the transition. This community is amazing and will help you every step of the way. I couldn't have made it through the last couple of weeks without them.

 

Hello,

Eating does raise a cat's BG. That's why we feed low carb food normally to keep their BG from going too high. It's best to get rid of the dry food if you can. I leave wet food out for Furball during the day and pick it up when I get home from work. She's a grazer too. I do the same thing at night. It is best to avoid them eating about 2 hours before PS time.

You do not need to shake or roll the pen to mix the insulin. Some vets still think you need to do this because you had to with older insulins. It's best not to inject anything back into the pen because it is pressurized. Since you didn't know this, you can't do anything about it. You can still use the pen, but it may make the pen not last as long. If you start getting really wonky numbers or see any floaties in the pen, you'll need to get a new one.

 

ok, I'll get rid of the D/M dry food and leave out some wet food for Spike for grazing during the day, and make sure I pick it up 2 hours before the pre-shot time. Do you leave wet food out at night for grazing too, or just during the day? thanks.

 

I feed Max mini meals sometimes every hour or two until +6-7. He's been a grazer and that works well for him. I pick up his food at that point day or night. If you stop testing much earlier you could use an auto feeder.

 

I know a lot of people use the timed auto-feeders to give food while they are out/sleeping. Would not work in my house since I have 4 hoovers!

 

I'm trying to get into some kind of routine b/c although I sometimes work from home, I am more often gone most of the day, so I'd like to feed him a few small meals during the day, but my schedule won't allow it. So, I think I'll just leave out some wet food during the day and pick it up 2 hours before pre-shot testing.

also: I thought auto-feeders only worked with dry food?

 

You can use auto feeders with wet food. It has to be the kind with a dish or dishes that stays horizontal and a door opens over the dish, or the dish rotates to an uncovered place. Does that make sense? I mean, just not the kind that drop and dispense measured amounts of dry food.

Yeah, the dry food makes a difference. But as people have said, once you withdraw it, you need to monitor carefully for a bit because you may see a drop in overall BG level and that could mean you need to change the insulin dose. My Rosie also has been a grazer all of her 19 years. She eats only wet and I have the luxury of both my husband and I working from home. But when we go out, we leave her wet food.

I DO think you might want to read some of the stickies here about testing before each shot. That's very important. You want to know where the BG level is before you shoot and you want to test after the shots to understand when the insulin begins having its effect and when Spike reaches his low BG point in the 12-hour cycle. We are very careful about keeping dosing consistent and making changes in dose only when certain conditions are met. It all seems overwhelming and impossible at first, but you will be surprised, I think, at how you can get into the groove and take a lot of comfort from knowing that you are in control of the situation.

Wishing you the best of luck with Spike. You should get lots o f helpful information here.

 

I leave wet food out at night too.

 

so wait, I'm still not clear about this. I understand that I have to take away spike's food 2 hours before I test his BG before his am and pm insulin shot, but I want to test spike's BG during the day as well, so since I leave out food for him during the day as a grazer, when I want to test his BG at other times during the day, do I have to take his food away 2 hours before I test his BG levels??

 

My sugarcats past and present are grazers. I never changed up their routine if I was doing a BG curve.

 

When you test during the day, you do not need to take his food away. You take his food away 2 hours before Pre-shot time so his number before you give insulin is not food influenced. It would be impossible to take food away 2 hours before you test every time you test. We're really only concerned about the pre-shot tests not being food influenced.

 

The PetSafe5 is a favorite auto-feeder around here. You can program it to open several times over the day (and night!) to offer food when you're not there (or want to sleep!)

You just program it to have an empty compartment 2 hours before the Pre-shot tests so when you do them, those tests are without the influence of food

 

Rusty is a grazer and has wet food available, day and night. If we will be out all day, we use the auto feeder because it helps keep the food from getting too dry (we use the CatMate C-20, two-compartment feeder with separate timers for each compartment; it comes with a cold block that fits under the compartments and helps keep the food cool in hot weather. Chewy.com has a good price on it). Many people prefer the feeders with 5 rotating compartments, but I have never had success with programming them.

If a pre-shot number is food-influenced it will give a false impression. The bg number might be higher because of the food, but the "real" number (not food-influenced) might be much lower. The whole idea of no food 2 hours before the insulin shot is to keep the cat safe. Dosing is based primarily on the nadir--the lowest number of the cycle, usually occurring at mid-cycle; but if the pre-shot number is low you will want to be vigilant as the cycle progresses. A food-influenced higher number might lull you into thinking that your kitty will be safe for the cycle.

Ella & Rusty

 

Welcome, Mary! Spike is one very handsome kitty.

I want to encourage you to read the stickies at the top of the Lantus & Levemir page when you can, especially New to the Group? and Syringe and Insulin Info There is a TON of info there that will help you understand more about FD and what we do here. Don't worry if you feel overwhelmed - there is a lot to process and you're probably still a bit shell shocked from the diagnosis. The biggest thing is: Don't be afraid to ask questions. If you don't understand the answer, ask for clarification (like you did above). The only dumb question is the one you don't ask.

As previously mentioned, it is really important to get a test before you give the insulin, so you know that it is safe to shoot. We use the abbreviation t/f/s a lot. That means Test/Feed/Shoot. You want to test, then make sure kitty will eat, then shoot. It also helps a lot if you can get some random tests during both the day and night cycles. If you work all day, try to get an "out the door" test before you leave, and a before bed test at night. I know it doesn't make sense, but the night cycle is often very different from the daytime cycle. Lantus dosing is based on how low the cat goes, not on what the preshot number is, so if you don't know what the insulin is doing to his numbers, you don't know how effective that dose is.

If you ever get a number that makes you wonder if you should shoot, post here with a ? in your subject line and something like: "Spike BG 120. Shoot?" You will get a response from several members, most likely.

Sorry to throw so much at you. There's much more to learn, but know that you are in the best possible place to help Spike. The people here live this 24/7, many have done so for years and many have/had more than one cat with FD (I have two). We care about each other and each other's cats, and someone helped us when we were new, so we want to return the favor.

BTW, I also use the PetSafe 5 compartment feed that Chris linked. It has a place for an ice pack underneath. It works great.

 

ok, but won't I get inaccurate BG level numbers when I test during the day b/c I have not taken food away 2 hours before? I'm confused.

 

They're not inaccurate. You want to know what the food is doing to his BG, too. We often use food to steer BG, as well - give slightly higher carb when numbers go too low, etc. The reason you want a non-food influenced reading at shot time is so you know for sure that the number is true and if it is safe to shoot. That's the only time it matters. It is assumed the other tests will have food in play.

 

I must be dense b/c I still don't understand If we want to know how low our cats get during the day, we want to know the lowest number our cats go (correct?), especially around the 5-7 hour time frame after our morning shot of Lantus, then why would we want that number to be affected by food??? I really don't understand... sorry! :/

 

It's a logical question, but it doesn't take into account that everyone has to eat sometime or other! Food during the cycle helps to keep your kitty going. Some people feed most of the cycle's food before nadir, dividing it into small portions. Others let their cats free-feed (grazers will portion out their food themselves). Some people find that a snack at about +9 works well for their cat. You will find what works best for Spike. Don't forget that after you give the shot, Lantus will "kick in" in about 2 hours. Thereafter the insulin is working throughout the cycle (with it's effect getting weaker toward the end of the cycle). You'll be able to see how different foods affect the playing out of the cycle. Every Cat Is Different (ECID, an abbreviation you will encounter a lot on the FDMB)

Keep on asking questions, Mary!

Ella & Rusty

 

Mary, if you were a scientist doing a lab experiment, yes, you would want to record each test under exactly the same conditions. But since this is real life in real-kitty world, the method is to allow the poor dears to eat as normally as possible, restricting food only for two 2-hr periods a day--once before each shot. Sometimes, Rosie eats and then comes back into the kitchen for more, say, 3 1/2 hours after her shot when I was thinking I would do a +4. So then, usually, I test a little early and let her eat. But I would not keep her food away unless I had to.

Part of the reason for testing is not so much to see how low this dose of insulin could possibly take your kitty. It's more how low does it take your kitty in his or her normal circumstances. When you gather a bunch of tests together, you get an idea of what a typical cycle is like for your kitty, food and all.

 

Great explanations here! One more thing to add to the explanation of why you feed during the cycle and don't worry about whether or not the tests are food-influenced is that when the cat eats small meals it can help to even out the blood sugar. That's a good thing.

Punkin ate everything that was set out the moment it was out, so grazing was not an option. We used the Petsafe 5 compartment feeder and loved it. The key to getting that to work reliably is to always make sure the food tray is fully seated into the base unit. You can check to make sure it's fully seated and moving correctly by pressing a manual button to advance the food tray one slot. As long as that happens, you've got it.

We fed most of his food at preshot and half again as much at +3, both am and pm cycles. Other than that, we sometimes gave some cooked chicken. The reasoning for having most of the food in the first half of the cycle is that the insulin is most potent and lowering blood sugar in the first half of the cycle. Once you're past the low point in the cycle, or nadir of the cycle, then the insulin's strength is waning. Eating a lot at that point can drive up blood sugar in the second half of the cycle. On the other hand, if a cat will self-regulate and just graze, that can often work just fine without having the blood sugar go up excessively. Just depends on the cat. As you go along trying out various things - like does it work better to graze or feed most of his food in the first half of the cycle - it will help you figure out things if you take good notes in your spreadsheet comments section.

The only time it would really matter if you fed right before the shot is if the blood sugar were really low. If it's 300, do we care if it's food influenced? Nope. Not going to matter. If it's 55, do we care? Yes. Then it would matter.

If you can wean him off the dry food that would be best. A cat eating high carb food can get larger doses of insulin to compensate, but it's much like a human diabetic eating candy and cake all day and just increasing their insulin to compensate. It's just not a good practice.

I made the Lantus video - the only issue is that our syringes now have a lubricant in them - you just don't want it in your insulin. But if it's done - don't worry about it. If it shortens the life of your insulin a little, you may or may not even notice it. For now, just keep using it but have in the back of your mind in a few months that if you start seeing higher numbers, like the insulin isn't working as well as it was working, it could be from contamination. You should still be able to get plenty of time out of the pen though. At any point if you see the insulin become cloudy or develop stringy material in it, then I would assume the insulin is contaminated and get new insulin.

I noticed you gave 2.25u yesterday morning, 2.0u last night and 2.1 this morning. Lantus works best if you don't change the dose too often. That's because of it's depot. When you change the dose, the depot will grow or decrease in response - the depot is in equilibrium with the dose. The depot can take 4-6 cycles to adjust to get back into equilibrium with the dose size, so changing the dose too often doesn't allow that depot to work at its best. There is a great link on the sticky about the depot on the difference between Lantus and Levemir. Reading it will give you a great understanding of how Lantus works.

Next time you see a blue number, I'd continue testing to see where it's going to go.

Congrats on getting started. All of this gets infinitely easier as you learn more. The beginning is challenging, but we'll help you. Just keep asking questions so you understand. We've all been in your shoes and we get it. And welcome to the group!