Low glucose

[Vanlora Light]

So I am new to this forum and I need some help.
My cat Missy who is a male 14 year old was diagnosed with diabetes 1 april 2021. I've been going in and out of the vets office for months after the diagnosis and his sugar was always very high even tho the vet increased the dose from 1 to 2 and then 3 units twice a day. Recently I've bought alphatrak glucose meter and been monitoring at home and changed his diet to low carb wet food.
His numbers now have been better than before. I don't have the spreadsheet yet but I've written the glucose numbers down on a paper.
What I need help with now is some advice.
So I woke up today and before giving insulin (lantus) his glucose was 3.8mmol/l and I decided not to give insulin and just fed him. 30min later it was 4.8mmol/l. I asked for advice in a fb group but they told me to ask for advice here.
What should I do? Not give him insulin? I am using Lantus pen so I can't decrease the dose by 0.25 or 0.50. I'm thinking about getting the syringes but what should I do in the meantime? Rn he gets 3 units twice a day.
His glucose now 3 hours later is 6.6mmol/l

 

[Bron and Sheba (GA)]

Hi Vanessa and welcome to both you and Missy to the forum. I am glad you made your way over here from the fb page!
I hope you skipped the dose of insulin for this cycle. The 3.8 was too low and you had fed him which would have influenced the next BGs
I’ll post this so you can see it and then write more.
Did Bhooma @Bandit's Mom help you set up a spreadsheet on the fb page? I thought I saw someone had mentioned that.

 

[Bron and Sheba (GA)]

I mentioned the U100 3/10 30 or 30 gauge 6 or 8 mm 1//2 unit syringes that you will need to buy as you are using a pen at the moment. As you live in Finland you may not be able to get some of the brands but I did see someone from Denmark mention the BD brand of U 100 syringes.
Let us know how you go with that.
As Missy went lower than normal this morning it is possible he could bounce up high later in the cycle. If this happens, don’t be alarmed. Bouncing is normal and happens when a cat drops too low, too fast or lower than he is used to. He then panics and dumps stored glucose and regulatory hormones into his system which sends up his BG. Bounces can last from 1 to 6 cycles and there is nothing you can do about them but wait it out.

I would reduce the dose to 2.75 units, if you are able to buy the syringes. If you can’t, post here and someone will tell you what to do. I think if you have to use the pen, you will have to go back to 2 units until you can get the syringes. Not ideal but safer than staying at 3 units. If he is still in lower numbers at the next preshot time, post and ask for help. You will need to change the subject line and put something like ‘preshot xxx new member HELP’ to get attention

Can you tell us what you are feeding him and when please?. Are you giving snacks during the cycles as well as the preshot meals?.
I am heading to bed now but I am going to ask @Bandit's Mom and @tiffmaxee if they can help you further as they are online now or coming online a bit latertoday.
Ask as many questions as you like. Everyone here is happy to answer them and w have vey experienced people here who have looked after diabetic cats for many years.
Bron

 

[Vanlora Light]

I mentioned the U100 3/10 30 or 30 gauge 6 or 8 mm 1//2 unit syringes that you will need to buy as you are using a pen at the moment. As you live in Finland you may not be able to get some of the brands but I did see someone from Denmark mention the BD brand of U 100 syringes.
Let us know how you go with that.
As Missy went lower than normal this morning it is possible he could bounce up high later in the cycle. If this happens, don’t be alarmed. Bouncing is normal and happens when a cat drops too low, too fast or lower than he is used to. He then panics and dumps stored glucose and regulatory hormones into his system which sends up his BG. Bounces can last from 1 to 6 cycles and there is nothing you can do about them but wait it out.

I would reduce the dose to 2.75 units, if you are able to buy the syringes. If you can’t, post here and someone will tell you what to do. I think if you have to use the pen, you will have to go back to 2 units until you can get the syringes. Not ideal but safer than staying at 3 units. If he is still in lower numbers at the next preshot time, post and ask for help. You will need to change the subject line and put something like ‘preshot xxx new member HELP’ to get attention

Can you tell us what you are feeding him and when please?. Are you giving snacks during the cycles as well as the preshot meals?.
I am heading to bed now but I am going to ask @Bandit's Mom and @tiffmaxee if they can help you further as they are online now or coming online a bit latertoday.
Ask as many questions as you like. Everyone here is happy to answer them and w have vey experienced people here who have looked after diabetic cats for many years.
Bron

I didn't give him insulin today yet, bc it was too low, I took his glucose again and now it's 6.6mmol If he bounces really high during the day should I give him insulin then or wait until next insulin time(today evening) ?

 

[Bron and Sheba (GA)]

If he bounces really high during the day should I give him insulin then or wait until next insulin time(today evening) ?

Good question…..and the answer is no. You need to wait until the next preshot time.
Just feed him as you normally do, giving snacks etc. it is not going to hurt him if he does go up a bit higher. Much safer than too low.

 

[Bandit's Mom]

Hi Vanessa!

Welcome to FDMB! This is Bhooma and we've chatted a few times on our FB group.

This is our Lantus forum and there is a lot of information there at the top as "Stickies". It's quite a bit to take in all at once so you may want to just take it slowly!
https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

A change in food to low carb can make a significant difference to blood sugar numbers. We have had cats who dose has halved (or more) and cats who have gone into remission because of a diet change. That is one of the reason we stress on home testing so much - so that you can catch the lows and make dose changes accordingly. Without enough tests, too much insulin can look like too little insulin. What happens when the dose is too high is the cat's body fights to stay alive. The insulin may be trying to drive the blood glucose down too low and the pancreas will release stored hormones and sugars to bring it back up fast so too much insulin can actually look like it's not enough!

I think you should be able to find the BD Ultrafine Demi + syringes at any pharmacy. I don't know if you need a prescription for it in Finland.

Also, most of us use human meters. We test a lot and strips are much cheaper than pet meters.

It would help us greatly if we can set up your spreadsheet. We are very data driven here when giving dosing advice and need to see test data across a few days to understand how the cat is behaving on a dose. Can I help you set that up? It will take me only a minute to do so.
How to Create a Spreadsheet

 

[Vanlora Light]

Hi Vanessa!

Welcome to FDMB! This is Bhooma and we've chatted a few times on our FB group.

This is our Lantus forum and there is a lot of information there at the top as "Stickies". It's quite a bit to take in all at once so you may want to just take it slowly!
https://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

A change in food to low carb can make a significant difference to blood sugar numbers. We have had cats who dose has halved (or more) and cats who have gone into remission because of a diet change. That is one of the reason we stress on home testing so much - so that you can catch the lows and make dose changes accordingly. Without enough tests, too much insulin can look like too little insulin. What happens when the dose is too high is the cat's body fights to stay alive. The insulin may be trying to drive the blood glucose down too low and the pancreas will release stored hormones and sugars to bring it back up fast so too much insulin can actually look like it's not enough!

I think you should be able to find the BD Ultrafine Demi + syringes at any pharmacy. I don't know if you need a prescription for it in Finland.

Also, most of us use human meters. We test a lot and strips are much cheaper than pet meters.

It would help us greatly if we can set up your spreadsheet. We are very data driven here when giving dosing advice and need to see test data across a few days to understand how the cat is behaving on a dose. Can I help you set that up? It will take me only a minute to do so.
How to Create a Spreadsheet

I just took his glucose again at 5pm and now it's 17.4mmol! And I'm afraid it will keep rising until his next insulin which is at 9pm today.
If his glucose is very low in the morning and I can't give insulin then, then what do I do when it rises this high during the day without insulin?

 

[Bandit's Mom]

I just took his glucose again at 5pm and now it's 17.4mmol! And I'm afraid it will keep rising until his next insulin which is at 9pm today.
If his glucose is very low in the morning and I can't give insulin then, then what do I do when it rises this high during the day without insulin?

He is rising so fast not just because of the missed dose but also because of a phenomenon we call "bouncing".

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is too low. Bouncing can also be triggered if the blood glucose 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 to save the cat from going hypoglycemic. The action is often referred to as "liver panic" or "panicky liver". A bounce can take as long as 3 days (6 cycles) to clear the cat's system.

Till the bounce clears, you might see flat and high numbers. That is not to be misconstrued as insufficient inulin. Lantus dosing is based on how low the dose takes the cat. We ignore the bounces. They are upseting (to see such high numbers) but unavoidable. As the cat's body get used to lower numbers, bouncing reduces and ultimately stops.

A skipped shot is a good opportunity to change your shot time - should you wish to. We ask our members to shoot at a time such that they can get a test before bed - anywhere between 2 and 4 hours from the shot time.

 

[Vanlora Light]

He is rising so fast not just because of the missed dose but also because of a phenomenon we call "bouncing".

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is too low. Bouncing can also be triggered if the blood glucose 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 to save the cat from going hypoglycemic. The action is often referred to as "liver panic" or "panicky liver". A bounce can take as long as 3 days (6 cycles) to clear the cat's system.

Till the bounce clears, you might see flat and high numbers. That is not to be misconstrued as insufficient inulin. Lantus dosing is based on how low the dose takes the cat. We ignore the bounces. They are upseting (to see such high numbers) but unavoidable. As the cat's body get used to lower numbers, bouncing reduces and ultimately stops.

A skipped shot is a good opportunity to change your shot time - should you wish to. We ask our members to shoot at a time such that they can get a test before bed - anywhere between 2 and 4 hours from the shot time.

Ah that makes me feel a bit better, I feel panicky every time I see it rise so high, now it's at 19mmol I wonder if bounces are this high... He is gonna get insulin soon

 

[Bandit's Mom]

Ah that makes me feel a bit better, I feel panicky every time I see it rise so high, now it's at 19mmol I wonder if bounces are this high... He is gonna get insulin soon

Oh yes! Some cats bounce all the way to HI on the glucometer! With time, the bouncing reduces. It takes a few months to regulate a cat. That's why we say this is a marathon and not a sprint!

Were you able to get the syringes so you can dose in fractions of a unit?

 

[Vanlora Light]

Oh yes! Some cats bounce all the way to HI on the glucometer! With time, the bouncing reduces. It takes a few months to regulate a cat. That's why we say this is a marathon and not a sprint!

Were you able to get the syringes so you can dose in fractions of a unit?

Not yet! But I will look for them tmr bc today was national holiday in Finland and I couldn't get to the pharmacy on time. My cat has definitely been doing better after I discovered these helpful pages, I wonder why my vet never mentioned anything about home testing when he first got diagnosed

 

[Bandit's Mom]

Would also be great if you can set up the spreadsheet. It's midnight for me and I'm headed to bed now, but I can set it up for you tomorrow.
I'm going to send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.

In case you can't set it up, send me the details and I will do it for you tomorrow.

 

[Vanlora Light]

Would also be great if you can set up the spreadsheet. It's midnight for me and I'm headed to bed now, but I can set it up for you tomorrow.
I'm going to send you a PM with the details I need. Look for it in the Inbox at the top right corner of this page.

In case you can't set it up, send me the details and I will do it for you tomorrow.

I sent it
I woke up again with his glucose being low 3.mol and I'm not sure what I should do again bc last time I waited and it got so high 23 mmol I'm not sure if waiting is the best thing bc he doesn't feel well when it's so high and he stops eating, I don't know if I should check his sugar again after few hour and when it's 8-10mmol I should give him some insulin? But a lower dose? He gets 3 units twice a day... Maybe 2 units? Bc lantus starts working hours later anyway and I'd give him some food too when he gets insulin

 

[Bron and Sheba (GA)]

He needs a lower dose, but you need to buy the correct insulin syringes so you can lower the dose by 0.25 unit increments.
If you haven’t got the syringes yet, I would go back to giving 2 units twice a day until you get the syringes and then we can work out the best dose.
Make sure he gets a good meal just before the insulin dose and then give him a couple of snacks say 2 and 4 hours after the dose each cycle.

 

[Vanlora Light]

He needs a lower dose, but you need to buy the correct insulin syringes so you can lower the dose by 0.25 unit increments.
If you haven’t got the syringes yet, I would go back to giving 2 units twice a day until you get the syringes and then we can work out the best dose.
Make sure he gets a good meal just before the insulin dose and then give him a couple of snacks say 2 and 4 hours after the dose each cycle.

What about right now? Will I wait until the next dose? Even if the sugar will rise all the way to 23mmol?