? 5/20 New member - need help

meli

meli

Member
Not sure what to ask or if this is the right place in the forum. I know I haven't been that great at regular testing, but I'm not sure how many times I should be checking her BG in a given day. I'm a little scared and feel like I'm doing it all wrong. Anyway, her numbers over the last couple of days have been all over the place and since I was home today, I decided to check her BG every 3 hours. We were at 453 (hard time with the ear poke), then 271, then 80, and now we are at 103. Not sure if I should give her any insulin tonight. She hasn't been eating well this afternoon so maybe that's why her numbers are dropping? Any advice is appreciated and TIA

previous post on FDMB https://www.felinediabetes.com/FDMB/threads/new-member-5-9-25.300712/ if anyone finds it useful
 
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Hello and welcome. I'm afraid your initial post didn't actually make it onto FDMB, part of the reason we are on this back up forum. I'm going to quote that post here, then answer your question in my next post to you:
Hello all,

Frisky is 14 and was diagnosed in February. I have been lurking for a while lol. It's been an up and down road so far and I am a little frustrated with my vet. Mainly because I'm confused.

Frisky never had any health problems but back in January she started hiding and looked...unkempt, for lack of a better word, so I took her in to the vet. They did blood work and her glucose was 463. Fructosamine checked and confirmed diabetes diagnosis.

Got a Libre 3 CGM and started insulin (Lantus) at 1U. Numbers got low, 60s mostly. She ripped off the monitor about 12 hours in. Took her back to the vet, they did a glucose curve, and after 2 more visits for BG checks with her numbers being between 100 and 200, they decided she was in remission and we stopped the insulin.

About two weeks later, I noticed she was drinking and peeing a lot, so back to the vet we went. Another Libre 3 CGM and started on 0.5U of insulin. We managed to keep the monitor on her for the whole two weeks but her numbers were constantly above 400 until we changed her dose to 1U again. This was about five days in. She dropped into the 50s and the vet almost switched to a different insulin but decided last minute not to. Said to go back to 0.5U and keep it there for a week.

In that time frame, her numbers were always too high for the monitor to read and the vet said he was ok with her numbers being high as long as she was acting herself and eating well. I came to the forum here and the more I read, the more angry and scared I felt.

Decided to get a ReliOn monitor so we could test her at home. My thought was she needed to be on 1U insulin minimum but she probably wasn't eating enough to support that amount of insulin. So I started feeding her more often throughout the day. She gets one can of Fancy Feast pate in the morning and one in the evening and I do my best to give her half a can every 4-5 hours during the daytime. Easier to do when I'm not at work.

I upped her dose to 1U and did a curve on Tuesday, but now I am lost. Was going to wait a week and then up her dose according to the SLGS method but unsure if that's the right choice given that her numbers are higher today, in the 400s. Maybe because stress but not entirely sure. Sometimes the ear prick goes well and other times not so much. I know there are times I have punctured the vein instead of hitting the sweet spot but I'm hoping that gets better with practice and as her ears learn to bleed. I was going to post for help sooner but there were issues with that. Seems the webmaster fixed them now.

So I guess the main question is should I wait a week and do more ear pricks to see what's going on before increasing her dose? Do I need to do more BG tests as we learn how the insulin actually affects her? Where do I find syringes with 0.25U measurements? And should I test her for ketones as well? How far is too far for a drive to the vet? If I have to find a new vet, the closest city is 30-45 mins away

Any suggestions are welcome and thanks in advance
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Since your signature says you are following SLGS for dosing, that 80 today says you need to reduce the dose to 0.75 units. Do you have 1/2 unit marked syringes? We eyeball those in between doses.

As long as Frisky was not diagnosed with ketones or DKA when she got her diabetes diagnosis, it's probably best if you skip tonight's dose. We suggest that new people do not shoot under 200. The SLGS dosing method, description here: Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) also suggests not shooting under 200 when you are new. As you gather data, you'll be able to lower that no shoot number.

Theoretically you should be posting over on the Welcome and Main Forum to start, but since you have the spreadsheet set up, it's OK to post here as that forum isn't getting as many eyes on it yet.
 
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OK, now that I've got the dosing question out of the way, let's talk about testing. Ideally you should be getting at least 4 tests per day. That's the two preshot tests, plus at least one other each cycle. The night time one can be before you go to bed, hopefully that's at least 2-3 hours after the PM shot time. Many cats go lower at night. We determine how to change the dose based on how low the dose is taking the cat, hence the need to see what he's doing overnight.

What you did today was a great example of a curve and why it's a good idea to mix up the times that you test. Cat's "typically" nadir (lowest point) is about six hours after the shot, but cats are all different and may change when they nadir from day to day. Some cats like to nadir earlier my girl liked to nadir 7-9 hours after her Lantus shot. On Levemir insulin it was even later. What you need to do is find out when Frisky most often has her low point. You can use that knowledge to know when it's best to test, to try to catch those low points.

When cats are in lower numbers, they also won't feel the need to eat as much as when they are in higher numbers.

What you are seeing with "numbers all over the place" aka the most common comment from new people, is what we call a bounce. Here is the description:
Bouncing is simply a natural 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 BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". 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 from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
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Perfectly normal, and annoying to us!
 
Ok, thank you. I feel better having an idea of what to do. How should I proceed in the morning? She usually gets her insulin around 11am but if we skip the dose tonight, when do I give it tomorrow? Tbh, 9 would be a better time for her shots if I need to get a BG before I go to bed.

I don't currently have 1/2 unit syringes but I can pick some up at the vet tomorrow morning.
 
I have been using these half-unit marked syringes based on FDMB recommendation. Chewy may stock them as well.

How did the rest of the night go?

(I'm pretty new so I can't help with the other questions, sorry!)
 
I didn't give her last night's dose, but she threw up twice and hid under my son's bed. Since it was 1:30am, I just let her be but she doesn't seem to want to eat this morning either. Usually she's waiting for breakfast at 7:30 with everyone else. And she's still under my son's bed...saw her for a minute right after he woke up, but as soon as she saw me poof she was gone
 
Hi Meli, welcome. I am not an expert here, but I can share my experience that when my cat's numbers started to come down quickly he started hiding at poking time for the first two days. Then all of a sudden last night he was like his old self, feisty, out and about, and ready to play. For my cat it seemed like he almost needed a reboot time and then he was back out and about. I hope the same for you and Frisky! Good luck!

Also as a newbie, using an electronic hand warmer and a little Vaseline were HUGE game changers for getting blood for the reader. (lot of people use a microwaved rice sock) I use the hand warmer on his ear for 15 second and then add the vaseline, then poke the back of the ear. For my cat I get better blood when I come towards the center of the ear a little from the picture of the sweet spot here on the forum.
 
mady and egon said:
Hi Meli, welcome. I am not an expert here, but I can share my experience that when my cat's numbers started to come down quickly he started hiding at poking time for the first two days. Then all of a sudden last night he was like his old self, feisty, out and about, and ready to play. For my cat it seemed like he almost needed a reboot time and then he was back out and about. I hope the same for you and Frisky! Good luck!

Also as a newbie, using an electronic hand warmer and a little Vaseline were HUGE game changers for getting blood for the reader. (lot of people use a microwaved rice sock) I use the hand warmer on his ear for 15 second and then add the vaseline, then poke the back of the ear. For my cat I get better blood when I come towards the center of the ear a little from the picture of the sweet spot here on the forum.
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We were using a pill bottle with hot water in it, but finally started using a rice sock yesterday and it made such a difference! It's good to know other people have cats who hide in this situation :)
 
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