5-30, Jessi PMPS 228, 56@+4 , 410@+10 no appetite

At Day 5 of Lantus 1.5, we had a night of nearly becoming Hypo at +4. I got scared and probably gave her too much sugar. She hasn't eaten for hours and now she is up at 410 and not wanting food.

I haven't given the AM shot yet and I am waiting for her to eat and for advice.


Previous post
https://www.felinediabetes.com/FDMB...pmps-228-56-4-5-lowest-numbers-so-far.278057/

 

Hi Stefania,

The Libre does read much lower at normal numbers than a regular meter. We ask members to verify a lower number on the Libre with a ear poke - if I remember right, that is not option with Jessi? Will she not tolerate even the occasional test?

Since you are following SLGS, that drop below 90 last night earned a reduction to 1.25U. Considering that you feed 100% wet food and you have a Libre, do you want to consider following TR? That will enable you to hold a dose where she sees good numbers. The idea is to have them spend as much time in normal numbers as possible. The normal range with a human meter is 50-100 mg/dl.

I haven't followed previous condos, so apologize if I am asking the same questions again, but does Jessi get small snacks every hour or two in the first part of the cycle? That will help reduce the drops and "flatten the curve".

Has she eaten this morning? I would go ahead and give 1.25U (assuming that you are following SLGS)

 

Hi Bhooma,

Thanks for your message. She ate almost half a can, but clearly has a reduced appetite and doesn't feel well.

I guess I get kind of scared when I see a sudden drop like that out of nowhere and it looked like it was still going down so I gave lots of sweet stuff which made it pop up. Usually when she is HYPER she is ravenous, it's weird that she isn't. She didn't touch the food I left out when I slept for 2 hours.

I will definitely reduce, but do you think .25 is enough of a reduction after such a sudden extreme drop? I thought Lantus was supposed to be gentler than Caninsulin, not causing these kinds of swings up and down.

I won't try to poke her ears right now, she becomes a crazy, terrified wild thing and then won't let me get close to her to do anything else. Plus the stress messes with her BGs and other health conditions too much.

She doesn't eat every hour but I do offer food pretty often. I could increase the frequency. Snacks you mean like treats or just a little wet food?

About TR, it kind of scares me. Not sure if I can handle it. I have the sense it will bring about even more events like this, am I wrong?

Can you give recommendations on how to dose 1.25 accurately?

 

Either she ate enough last night to fill her up or she is just not as hungry in lower numbers (below 250) - which is normal.

Yes. Go down to 1.25U. If she drops below 90 again, she would earn another reduction.

Lantus is definitely a gentler insulin than Caninsulin but newly diagnosed cats can see some BG swings - especially since they are likely to be more "bouncy". I'm also not sure how much of this is just the Libre - which can give wonky readings. Also, without food, numbers can go down faster which is why we suggest multiple small meals in the first part of the cycle rather than just 2 meals with insulin.

A lot of people have been where you are now. Using the Libre because the cat won't let them test. There is no urgency to try but you want to start trying to test her with regular meter. Treats before and after the test help. As does a routine. You could just start off by getting her used to you touching/handling her ears, then graduate to fake poking and then try the occasional poke. She can sense you anxiety and stress, so you want to be relaxed and pretend like it's a game or something very normal. I know this will take much practice and time...all I am saying is that others have got there and you could too! A

Just food. What you could do is a feed little less with the shot and feed smaller meals at +2 or +4. With time you will figure out how to "feed the curve"
Using Food to Manipulate the Curve

Here's a picture of what 0.25U looks like. It will be halfway between 1 and 1.5.


Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing

 

ok, that's pretty much what I did.

She is still not eating much which concerns me. She will happily eat the strong smelling snack we have, but her wet food she is eating very slowly. Ok, I will tryout what you are saying and read up on the smaller meals to feed the curve. That is new for me, so thank you for that.

I forgot about the page with syringe info, thanks for the reminder!

So is this normal on Lantus to go so low like that after 5 days on this dose? Is it just because I needed to feed her more frequently?

 

Just last week I got: Libre 2 237 and relion 143, PM PS L 240 and relion 149.

 

I know lower numbers can be scary initially, but it's great that she's have such a good reaction to Lantus. And yes, a cat can suddenly start seeing strings of lower numbers and earn reductions once they hit a breakthrough dose. And yes, feeding her small meals - especially in active cycles - will also help. You could feed a tsp of food after every hour or even 30 mins (if necessary).

 

Although we are still on Caninsulin, so not sure how much weight my comment has here, but I can 100% vouch for this. Once Rorschach's system has gotten used to (on about day 6) the 4IU, his nadirs started to drop like crazy. I had to reduce with a whole unit in just over a day / 3 cycles Again, it is just an example, and on Caninsulin. Lantus will behave differently, so do not do this (as in such quick and steep reduction) with Jessi.

 

She's not eating right now. I keep offering. I will try again. But so far the BGs are staying in the upper 200s

Does that mean the Libre is much higher than the glucometer??? That would mean that if the Libre read 56 her actual number was....??? It can't be that much higher, can it?

 

Since AM shot BGs are holding in the upper 200s. I gave as close to 1.25 as I could manage. It might have been a drop less, hard to say.

The Vet who oversees the sensor results and gives me dosing instructions (a team of vets actually working under a celeb endocrinologist in a University clinic here in Bologna), is telling me that from what they can see her response to the insulin is optimal including the low numbers. They are reminding me that the sensor does show lower values in the lower levels.

They said the same thing last time when she was on 2 x 2 and dipped down even lower after the first three days. They want me to continue with 2 u + 1u each day -- which I am not doing since I was advised in this forum to do 1.5 x 2. And they do not want me to lower the dose. The vet is telling me also to NOT to give syrup/carbs etc. unless the cat shows clinical signs of Hypo because of the spike that happens as a result.

What are your views on this? To me, it's terrifying to think of just letting her be there with those low numbers and the little arrow pointing down and do nothing but watch and hope she doesn't start convulsing. She is so lethargic so much of the day that it is very hard to notice a difference just by observing.

I have read comments in this forum too about letting the low numbers be, provided they are around the normal nadir time. But this was several hours earlier than nadir.

So was I right or not to give syrup and carbs and get them back up fast?

Should I be posting on the Lantus/Levimir page now? If so, how do I do that, same way I do here?

Btw, she did eat almost an entire 80g slowly about an hour and a half ago. But until she is ready to eat she won't take even a spoonful.

 

We got on a really late schedule because I stalled the insulin until finding out what dose to give. As a result, Jessi now wants her dinner at the usual time which is more than 2 hours before insulin time. Do I feed her or wait until closer to the time for the shot? I have to go out briefly to run an errand and I don't know which to do, feed a little now then a little more later before the shot or give her nothing and make her wait until later.

 

This is ridiculous and dangerous. Lantus works best when dose consistently since it is a depot insulin. So you give the same dose AM and PM. You are also seeing how low the 1.5U dose was taking her so giving 2U would be too much at this point. And why they would want you to keep her low enough to induce a symptomatic hypo is beyond me. Hypos can kill.

Later in the cycle you may not need syrup to get her numbers up since insulin action is waning. You could start by feeding MC and see if that is enough and if not go to HC and then syrup/honey.

Yes, just the way you do here, but on the Lantus forum. Here is the link to create a new thread in the LBL forum
https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/create-thread

What you could try to do is feed smaller amounts so that she is hungry enough to eat more often.

At higher numbers it isn't as important to not feed in the 2 hour window before the shot. Feed her less so that she will be willing to eat again a shot time.

 

From what I understand you weren't supposed to feed 2hrs prior testing PS when they're in a lower BG range. With that said, she has a Libre on, thus you can check what her level was before eating now or whenever and she's in a higher range still.
"If she was my cat" I'd give her a little food now to keep her content if she's hungry, and more before shooting.

 

I wouldn't feed a lot of carbs this late in the cycle. You can give a little bit of food, very low carb if you have it. You do want her to be still hungry and eat once you've given the shot. You also don't want her to get in the habit of demanding food this late in the cycle - those habits are hard to break!

Cats differ in their response to carbs. Some need really high carbs and/or karo to come up, some are fine with medium carb. Your job is to find out what works with Jessi. It can help to learn that information if you put some notes in the Remarks section of the spreadsheet whenever you do some feeding that is outside of normal. Record how much of what you fed to boost her up. Next time you see lower numbers or fast drop, don't give as much as last time, or lower the carbs. Over time you'll figure out what works best for Jessi. And just so you know, almost all of us over carb/feed our cats the first time we see lower numbers. Rather a cycle too high than a minute too low.

The vets got that part right, we have seen more differences in the lower blood sugar values when people here have tested.

 

It depends upon how long the Libre sensor has been in service and other things. The relationships of Libre BG and ear stick BG seems to change with time and become closer based on my experience. Usually I have had the Libre read lower than ear stick w/juman meter but w/last sensor the Libre was higher. That is why one should periodically compare ear stick with Libre reading @ both high and Low BGs.

 

Thank you all for your replies. This is so helpful.

I got 2 hours of sleep last night and that’s after more than a month of 4-5 every night. Naps rarelyhappen.

I can’t keep this up much longer.
Tonight I’m already feeling nervous because of last night. Her preshot was again lower than normal, 245 which makes me concerned the same thing will happen.

If any of you who are in the US time zone could keep an eye out for my posts in the next 7 hours or so in case we plunge again, that would be so so helpful. Part of why I panic is because I’m on my own and obviously also because I don’t have enough experience and understanding to feel confident in making the right choices. Knowing at least one person will be watching over me and Jessi would be such a relief. And having someone there to keep me calm so I don’t panic and overfeed sugar would be good too.

if you have any suggestions for how to get more sleep I’ll take them!

 

Update, for US people who are still awake:

171 @+4 after a day of .25 reduction (is that a cycle?)...I am hoping I can get a little more sleep tonight, but I may have to do the wake up every half hour or every hour thing...then again when they drop low they seem to do it suddenly, so it could happen while I'm sleeping...

She just ate a good portion of her usual LC food. I will give more now for the night.

What I have noticed for years now and what is coming up right now with Jessi is that she has moments when she doesn't seem to know she's hungry. I have to insist and insist until she finally starts eating and then she is gulping it down like she is ravenous. She can go hours without eating even though her body needs food just because she somehow doesn't know. It's like there is a disconnect between her brain and her body. In those moments it can be hard to get her to eat. And then there are the moments when she doesn't feel good but that's another thing.

I try to avoid using treats too much as stimulants because they are addictive and then they can make her not want her real food as much. Same goes for 'junk food' or HC food. The more carbs it has the more addictive it can be.

Then again, she puked up some of the HC concoction I made last night, so she might not be wanting that again. I never saw a cat go so bonkers over corn! Thank you pet food industry for making our animals into carb junkies!

Anyhow, I'm on night watch again...fingers crossed it is a much gentler curve tonight...

Thank you again for your support! It makes such a big difference! Jessi says thank you too!

 

A cycle is the 12hrs between shots. So a day is two cycles