Help with Skinny kitty with erratic BGs

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Kristin and Dewey, Oct 28, 2020.

  1. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020
    Hello everyone! My Dewey was diagnosed in May 2020. It has been a long, hard road and I still can't seem to get his insulin right. He has had large swings in his BG that can be terrifying to me. He got up to 4u Lantus but then had some hypo scares. The vet wanted to drop him down to 1u and I said no. She was not too happy with that but we decided on 3u and monitor closely. I worked slowly up and was back up to 3.75u with BGs still high. I began reading more about low weight kitties who don't gain and decided to up his food to 3, then 4 meals per day. Of course he needed more insulin because of that and I am bouncing between 4 and 4.25u. I think he might be having a Symogi affect on 4.25u and don't want to deplete his liver glucose and cause a crisis (this is what I think may have put him in the hospital last time). The ss are sort of confusing because I changed over to a human meter from a pet meter so I have 2 spreadsheets. The one in my signature is the current human meter and I did not have room to put the earlier one on my signature but there is a link in my comment section on my profile. I will also add it to the bottom of this.
    He has undiagnosed diarrhea issues and I am treating him with a probiotic. I tried pumpkin but he refuses any food with it mixed in.
    I also am tryiing a diet change to a food low in carb but not zero carbs along with his usual Tiki Cat because I read somewhere on here that some cats do better with a little carb.
    I have been giving him the extra meals for about 3 weeks with no weight change. I am not sure what to do now with dosing. I would love your opinion on this. It is so frustrating after 5 months! His BGs can be so irregular do I am afraid of keeping it too high. Help!

    Thank you,
    Kristin and Dewey

    Old ss with pet meter readings and history:
    https://docs.google.com/spreadsheets/d/1cSliZiYZ9L6ZA5ssUGeBM3gsl9omFB0e5lHDrr8gN4k/edit?usp=sharing
     
  2. thebigfuzz

    thebigfuzz Well-Known Member

    Joined:
    Mar 9, 2012
    Hi Kristin and Dewey!

    just wanted to pop by and say hello, Welcome :bighug:

    I’m sorry you have been having a tough time. I can relate that the swings can be unnerving. Some kitties crave a little more excitement than others :nailbiting:

    At first glance, you are doing a great job with testing, it looks like you are monitoring closely, which is a good thing.

    We have 2 dosing methods we use on the forum, TR (tight regulation) and SLGS (start low go slow). It is always helpful to choose one of the methods to start and dosing advice is given according to the method chosen. You are not married for life to the dosing method and can change your mind at any time.

    Here is the link:
    https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

    As for food, what food/carb are you currently feeding, what times do you feed and how much?

    I’ll leave it there for more experienced eyes on dosing, but again, Welcome!!!
     
  3. Christie & Maverick

    Christie & Maverick Well-Known Member

    Joined:
    Aug 1, 2017
    Tiki cat is quite low in calories, which may explain lack of weight gain. While many people get fixated on low carb ie. 1-2% many cats also do better in higher LC ranges, like around 5-6% it just depends on how carb sensitive they are. That is why in general, it is suggested to feed a less than 10% carb diet; however, we each have to figure out what works for our own cat.

    Cats need as much insulin as they need, so don't get too hung up on what the dose is. It seems to me that you have jumped around in doses a bit too much. Remember, with Lantus we dose based on how low the dose is taking the kitty, not preshots. I see on your SS you are unsure of what method to follow. There really is no "hybrid" of TR and SLGS, each has their own safety measures built in, so it is best to pick one, and follow it. You can of course change if you need to, but I wouldn't try and pick a little of one and a little of the other. Our advice on when to take reductions, among other things, will vary depending on which you follow. Also, I don't mean this in a bad way, just for future reference, never ever give insulin like you did on am cycle of September 11 where your AMPS was 33 :woot:. Even the most experienced members, who follow TR would never dream of shooting that low. It could have gone very badly.

    I wouldn't have reduced to 4 units today, so I would suggest based on what I see in your SS, you are fine to try and keep to 4.25u, and please do re-read the stickies on dosing methods. You are testing enough for TR, so as long as you aren't feeding any dry, you can follow TR, but ultimately it is up to you.

    https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
     
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  4. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020


    Sorry that was a typo....Looking at my notes it was actually 333. I would NEVER give insulin at 33. As for the insulin amount, I am not concerned with a high insulin number. What bothers me are the erratic swings in BG from PS to nadir that happens at times and don't at others even though food intake is the same. I have read the dosing methods already, and with the big differences that can happen with Dewey I guess I am not ready for tight regulation. I had read somewhere on this site that some members do something in between the two but if you are telling me I can't I would have to pick slgs. As I stated in my post, I am adding in half the meals a food with more carbs than Tiki. When I tried to do this before Dewey became very sick so I am slowly increasing the new food. I had read about the low carb but not zero carb being good for some cats already, hence why I am doing this.
    Am I wrong that he is very poorly controlled? Are you saying that is because I have switched between 4 and 4.25 when BGs are lower? At times his BG will drop dangerously low when his PS BG is around 250 or less, and sometimes it won't. I know Lantus is not supposed to have peaks and valleys but my cat IS having them. I have not increased dosing any faster than recommended (at least 6 cycles) unless it was when I was following my dr's advice which I am not doing anymore. The only exception is lately when I have been afraid of 4.25 being too high. I just don't want a third trip to the ER.
     
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  5. Christie & Maverick

    Christie & Maverick Well-Known Member

    Joined:
    Aug 1, 2017
    A couple additional thoughts.

    Whenever you adjust the dose, either up or down, you need to give it enough time to settle and see what the dose is doing. You've dropped to 4u for one or two cycles then gone up to 4.25u a few times lately which disrupts the depot.

    When cats get better regulated on Lantus, you do indeed see flatter cycles. You are seeing some bouncing, which happens either when a kitty drops quickly or drops to numbers they aren't used to.

    Bouncing - is simply a reaction to what the cat's system perceives as a BG value that is "too low". "too low" is relative. If a cat is used to BG in the 200s, 300s or higher for a long time, then even a BG o 150 can trigger a "bounce". Bouncing can also be triggered if the BG drops too low and/or too fast. The pancreas, then the liver release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream. *Usually* bounces clear within 3days (6 cycles).

    With SLGS you hold the dose for 7 days and evaluate. Are you feeding any snacks during the cycle, or just if you see a lower (green) number? I feed a few snacks earlier in the cycle in addition to the meal with insulin, it helps to slow down the drops somewhat. Hard to say why sometimes he comes down faster with preshots in the 250s, it is likely he is just metabolizing the insulin a little faster, although the numbers you saw on October 21st and 22nd wouldn't be considered dangerously low with a human meter. I appreciate you had a scare mid-September, so perhaps stick with SLGS for now and see how you go. It might be a good idea to test for ketones as well. You can get Ketostix, you just have to catch him peeing.
     
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  6. thebigfuzz

    thebigfuzz Well-Known Member

    Joined:
    Mar 9, 2012
    LOL @Christie & Maverick I was just typing the same thing when you posted yours :facepalm:

    I would only add that it is possible there may be something else too, with the digestive issues. Are you still seeing runny poops? Or has that resolved?
     
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  7. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020
    He has diarrhea still, intermittently. We did blood tests that didn't show anything major and the next step was an endoscopic biopsy. I had planned to do that but my last ER visit was a nightmare. Nobody would listen to me and there was no communication between staff. When my vet (who works there) called me the next day she had no clue even why I brought him in. He was lethargic and staggering around and his glucose had shot up to shot up to 655 after having a low in the 40s that die. She said she did not know any of that. She then told me because he was hypoglycemic on 2 occasions I should drop from 3.5u (which I dropped from 4u after the first incident....she was mad I had done that) to 1u. I flat out refused. she wanted to keep him another night to "monitor his BG". She did not want to listen to anything I had to say and has told me multiple times to not check BGs unless she asked for a curve and that would tell her all she needed to know. I went and got him that night rather than pay for another day at the hospital since I could monitor myself. Since then I have not wanted to deal with her anymore. I think she is the only specialist in the area so all I have now is my personal vet who doesn't have a clue about diabetes. I am going to manage him on my own for now. The diagnostics for GI are on hold. His diarrhea isn't horrible, just a day or two a week. I think if I can put weight on him he might do better. I have read on here that really skinny cats have a hard time regulating because of the lack of fat. He is 11.5# and his ideal wt is 15#. I gave him 4.25u and I will try sticking with that but it scares me, especially since I need to go out of town and my husband won't do BG checks.
     
  8. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    Well hello there Kristin! It sounds like you and Dewey have really been around the bend a time or two...or even three before getting here.

    Where have you been all this time?

    Not that it matters, but the dosing being so erratic can certainly cause Lantus to mis-behave. Lantus is a depot insulin - it needs a steady - consistent dosing regimen to work best. Same time of day every day 12 hours apart - increases and decreases by .25 unless you're being monitored for special circumstances by one of our experienced members.

    So let me ask, when Dewey was 'lethargic and staggering around' what was his blood glucose at that time? Since you've read the dosing methods - I'm sure you're familiar with the 'hypo kit' and it's contents?

    Secondly, I see that 'you need to go out of town' and DH won't do BG checks-that concerns me since that's a very dangerous situation - you'd never give insulin to a child without checking to see what the blood glucose is at that time - same for your cat - never, ever give insulin without getting a pre-shot test. Things change very quickly with cats and although you may see a safe number an hour or two prior to shooting, that is simply not enough information - I've seen cats drop dramatically from one hour to the next (my cat does that!)...so please be safe and never shoot without getting a test....which brings me back around to your being out of town; is there anyone you can hire to come in and help with Dewey's blood glucose numbers? If all else fails in that regard, perhaps boarding him would be best. How long are you going to be out of town for? A day or two or a week or more?

    Dewey's numbers look pretty good today - starting a little high which is normal, then a nice slide to nadir, then back up toward the end of the cycle...give the same amount of insulin tonight that you gave this morning - unless of course you find that PMPS is some crazy low number. If it is, you know to STALL, NO FOOD, ASK FOR HELP - test again in 20 minutes to see which way he's headed...

    And of course I have to ask, when you post tomorrow could you please follow the recommended format: DATE / KITTY NAME / AMPS ###

    So your title would look like 10/30 Dewey AMPS ### - if you have a question you can add it at that time.

    Great job on your signature and your Spreadsheet!

    I hope this information is helpful. Looks like @Christie & Maverick and @thebigfuzz have provided you with some excellent supportive advice already today.

    Take a deep breath and keep doing what you're doing - testing, and let's try to even things out for Dewey. Some cats just bounce...a lot - look around at some of the other condos and SS's here on the forum - you'll see the gamut of numbers and what all our kitties do...

    Please relax and enjoy your evening! Looking forward to seeing your post tomorrow :)
     
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  9. Christie & Maverick

    Christie & Maverick Well-Known Member

    Joined:
    Aug 1, 2017
    Here is something you might find helpful, it is calculating calorie requirements for your cat. It may be that you need to increase calories, and feeding to get some weight back on.

    https://www.petplace.com/article/cats/pet-health/how-to-calculate-your-cats-daily-calorie-intake/

    Was there any bloodwork done when you brought him into emergency? It might be worth asking for a copy of any tests they did, and some write up of his visit.

    So, if you decide to do SLGS after all, you'll need to reduce to 4u tonight, since he dropped under 90. With TR, you'd hold. If SLGS makes you more comfortable, there is nothing wrong with trying it out, and as you get more of a feel for how the insulin is affecting him (nadirs, onset, duration) as well as how the carbs you feed affect his cycles, we can look into personalizing things, since SLGS is meant to be a guideline. With SLGS the goal really is to try and achieve flat numbers that are higher than 90 mg/dl.

    As an example, we have some caregivers who have developed a good understanding of how their kitty responds to insulin, who choose to lower the reduction point. Instead of 90, they may decide they only reduce under 70. You may not be there quite yet, but keep it in mind for the future.

    Too quick of a diet change can result in some diarrhea, I wonder if that might be the case with Dewey?

    I need to check on my sugar kitty, so I'll check back later if you have questions.
     
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  10. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020
    He had the hypo incident earlier in the day (41 at +6, went slowly up to 151 at +9, I checked BG per protocol but didn't put all of them on the SS due to lack of space). Then he had diarrhea and later vomited up tons of food. He wouldn't eat at dinner time, BG 489, so I held his insulin. An hour later he was lethargic and staggering and his BG was 655. Then I took him to ER.

    I am supposed to go out of town tomorrow and was going to stay overnight but I may have to come back instead. I may be able to have my sister check some BGs.
     
  11. Kristin and Dewey

    Kristin and Dewey Member

    Joined:
    Jun 26, 2020

    I had already given him a 4.25u when I saw your post. Should I reduce to 4 tomorrow morning? I have the report from the last hospital stay but wasn't given the bloodwork. As for the diarrhea, it does get worse when I try to change the food unless I go really slowly. but he also has it at times when I haven't made any changes at all. I feel it is mostly under control now. The probiotic has helped.
     
  12. Christie & Maverick

    Christie & Maverick Well-Known Member

    Joined:
    Aug 1, 2017
    If you would like to follow SLGS, yes, I would reduce to 4u tomorrow. He will likely bounce from the 70s, so don't be surprised if he hangs out in some yucky numbers.

    It might be worth asking for a copy of the labs, something there may also explain the lack of weight gain. Maybe a stretch, but if it were me, I'd ask. A few of us, can help you understand the results, me a little :oops:, only in particular areas from past experience.
     

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