My anxiety about hypoglycemia

[Voula]

I have been reflecting on how anxious I have been since Lucy was diagnosed with diabetes. I have a huge fear about hypoglycemia which causes me to delay doses when Lucy's glucose levels are lower though not low and part of this anxiety is that Lucy does not seem to have higher glucose after eating. I see advice given that if you have to go out and your cat's glucose is a little lower or you are worried to leave some higher carb food out for your cat to eat. Once when Lucy's glucose level was lower close to AMPS than it was some hours earlier and I had to go out all day I fed her some high carb gravy canned food but her glucose levels kept dropping so I fed some high carb dry food which I haven't fed for months to see what would happen and again no change. Once when her glucose level was 3.3/59 for the first time I fed her high carb gravy canned food and instead of going up her glucose levels dropped to 2.3/41. The only thing that seems to increase her glucose level is honey. So I worry if her glucose levels drop when I am out that even if I leave food out it will make no difference. I don't understand why glucose levels drop after eating. When Lucy was first diagnosed with diabetes even low carb food seemed to cause a rise in glucose levels but not so much now. Thank you for reading my message.

 

[Tricia Cinco(GA) & Harvey]

I can totally understand your anxiety, and I have no advice to give you. It's late, so there are probably not a lot of the veterans online now, but hopefully someone will see this in the morning and have some words of wisdom for you. In the meantime, I will just say to hang in there and keep doing your best. I'm sure Lucy will work with you!

 

[manxcat419]

I think hypo is one of the things that makes us all nervous. I'm sure others will be able to better advise you tomorrow. I can appreciate how worrying it must be to have to go out when you're not sure what's going to happen later in the cycle but with any luck someone will be able to help you figure out a dose that's safe for Lucy and still effective.

 

[Voula]

Thank you Tricia and April for replying and for understanding too.

 

[Dyana]

I understand your fear. I went looking at your spreadsheet to see what time it was when she got the 59 and the 41, and if you are referring to January 8th, then it looks like the time when the insulin was at it's nadir which is the peak of it's effect. Giving dry food to bring up the numbers usually takes a lot longer than giving HC or honey.

 

[Tina & Sammy]

Sami doesn't have the same problem of dropping numbers even after food, but I have the same fear of hypoglycemia. You are not alone. I hope you are able to get it all worked out, and I will be watching this thread in hopes to learn something myself. Good Luck.

 

[Voula]

Thank you Dyana. Yes the lower numbers were at the nadir as you said. That is good to know about the dry food taking longer to have an effect.

 

[Voula]

Thank you Tina. It is clear I am not alone in my fear and it is good to know I am not alone in this worry I have a lot of the time. I am really trying to overcome it though I know I will not completely overcome as it is a normal fear but I want to overcome it a little as I worry it is affecting Lucy's chances of remission of her diabetes.

 

[monty_dweezil (GA)]

I hear you. When i do NOT give dweezil a furshot (ugh), and he gets his dose, i am always worried if he seems the least bit quiet that if i'm out for too long or if i go to bed that something will happen to him.

Each day i get home from work so relieved to see him alive. It is a constant fear. It's like a scary balance between keeping his levels slightly higher (no remission) but risking longer term damage, and trying for remission but living in fear...

 

[monty_dweezil (GA)]

Hmm.

 

[For Jack]

Hypoglycemia makes me nervous too. I'm glad that for now I'm able to be home more so I can keep an eye on him. However, I'm choosing to "trust" the way Lantus works. I like that unlike the Vetsulin he was on it doesn't do huge drops after his shot. I test Jack a lot because of my concerns though. Today, I shot in the green for the first time so I'm just keeping an eye on him. I think the most important thing to do is keep an eye out and know the signs. For instance, his +4 today was 48. Although with the margin of error in reality it could be higher. I'm not concerned though because his eyes look good and he's acting fine. Although the poor sucker is probably going to get tested again at +5 lol. Although, this is more so that I can be what they call "data ready".

 

[Elizabeth and Bertie]

Hi Voula,

My cat has been on insulin for 8 years now, and the idea of hypoglycemia can still sometimes frighten me.
Bertie has had 3 hypos, though hasn't had one for a few years now (touch wood/anti-jinx). And fortunately I was at home for each of those episodes.

In my view, the best general defence against hypoglycemia is gathering data and getting to know the patterns of how the insulin works in the kitty's body. I've learned that a test at +2 usually gives me an indication of what's going to happen later in my cat's insulin cycle. I can usually get a good idea of how much and how fast his blood glucose might drop.
But even when we're familiar with the typical patterns there are still all sorts of things we can't predict: Maybe the kitty is off his food. Maybe he throws up. Maybe his pancreas decides to do some more work that day...

It is difficult when we have to go out and won't be able to check the blood glucose as much as we'd like; especially if the preshot level was lower than normal. Occasionally I've skipped shots in this instance. More often I've given a reduced dose (even a teensy token dose at times so he has some insulin in his system).

If I see, after I've given the shot, that my cat's blood glucose is falling faster/further than I'd like, then I may make sure he eats something that I know will raise his blood glucose before I go out.
My experience of hypo has made me cautious; and I really do believe that, as the FDMB saying goes (regarding blood glucose), "It's better to be high for a day than too low for a minute".
But, as much as we might like to, we can't control every situation. Sometimes we just have to do our best and trust that things will be OK. And they usually are...

Forunately, hypoglycemia is actually a pretty rare occurrence in cats that are hometested. Many, many cats never experience hypo.
I think though that a little bit of fear in regard to hypo is no bad thing (as long as it doesn't consume you and make you miserable). That little bit of fear will make you careful. And you may be far better off than those who have a more casual attitude to hypo.

Eliz

 

[tiffmaxee]

i think we all are afraid of a hypo. I won't leave the house before I'm sure Max is not going to go hypo. I've missed out on lots by being that way. I am not one for giving dosing advice but I do wonder if you would be better with the go slow approach which if I understand correctly you don't increase as quickly. I wonder if you can find a dose that keeps Voula in blue that you can give consistently twice a day without having to skip doses if she would level out to the point that then you could increase? I don't know if this makes sense or if it is a good idea but just thought I would throw it out for others to comment.

 

[manxcat419]

I think though that a little bit of fear in regard to hypo is no bad thing (as long as it doesn't consume you and make you miserable). That little bit of fear will make you careful. And you may be far better off than those who have a more casual attitude to hypo.

I agree with Eliz on this. A little fear is good because it means that you keep your awareness that a hypo is dangerous. It means that you never get too complacent about the lower numbers. Rosa's had a few and while I can now deal with them and know she comes back up with the right food/honey, I'll never reach the point where I think it's OK to check her less when she's low or wait just a bit longer to give hc food because I'm aware of the risk of her staying in those numbers or going even lower.

 

[Elizabeth and Bertie]

I wonder if you can find a dose that keeps Voula in blue that you can give consistently twice a day without having to skip doses if she would level out to the point that then you could increase?

I don't use Lantus, Elise, but I'd also wondered whether a slightly reduced dose might level things out a bit.
Alternatively, if it happens frequently that a dose needs to be missed/reduced, or have it's time altered, it may be that PZI/Prozinc would give more flexibility; these insulins are much more 'forgiving' about dose changes and shot times.

Voula, it looks to me as if Lucy might have a 'sputtering pancreas' that works intermittently and can, on occasion, 'pick up the ball and run with it'; hence the (sometimes) long periods of surfing in nice blue numbers. If that is the case it is encouraging, but can sometimes be a pain to work with...
.

 

[Ann & Tess GA]

Yes, after 5 years of the Sugar Dance we still worry about hypos and it has altered our lives. That said, lower numbers do not automatically mean hypo, but that it's time to take steps to prevent a hypo from happening. Tess has dropped into the 30s several times over the years, but has never showed any hypo symptoms. If you have to leave and Lucy is lower than you are comfortable with and honey is the only thing that brings her up, give her some honey. Learn how long it effects her too, honey or karo can wear off quickly. A timed feeder might be a good investment.

The best you can do is study your SS and learn Lucy's patterns. Getting a check at +10 or +11 gives you a heads up as to which way she is headed at shot time.

One good thing you have noted:

I don't understand why glucose levels drop after eating.

this probably means that her pancreas is recovering and producing some insulin on it's own! Normally after a meal is digested the pancreas detects the increased glucose in the blood and releases insulin to open the pathways into the cells. This will lower BG because the glucose is being used by the cells and is no longer in the blood. It's why we advise that if a cat on an OTJ trial has a slightly higher BG to test again 2 to 3 hours later. If the pancreas is producing insulin, the BG will be lower.

 

[Sandy and Black Kitty]

Καλημέρα Βούλα

Am I correct in assuming you can read the above greeting?

I think though that a little bit of fear in regard to hypo is no bad thing (as long as it doesn't consume you and make you miserable). That little bit of fear will make you careful. And you may be far better off than those who have a more casual attitude to hypo.

I too agree with Eliz. A healthy respect for the power of insulin is a good thing.

I was thrown into the world of FD completely unaware that it even existed. In January of 2008, the heart of winter here, I took in Black Kitty, a local stray that I had been feeding outside for several months. Although in September of 2007 he was one very handsome Tom, by January he had become thin and frail and his eyes were weeping some sort of discharge. I knew he would not survive one more night. He let me pick him up and it was straight to the vet. He tested positive for FIV, had conjunctivitis and an upper respiratory infection. Blood was drawn sent out for analysis. The next morning I got the news that he was diabetic. My reaction was "What???"

I remember the anxiety of the first shot well. The dose was 1u Lantus. Besides the fear of being bitten, I was convinced that if I was successful at getting the insulin into him BK would immediately drop dead due to overdose. If someone would have told me then that in 7 months I would be using 2 types of insulin simultaneously and shooting some 45u per day I would have questioned their sanity.

Although extreme, our story is an example that fear and anxiety can be overcome.

Truthfully, in the 7 years I have been part of L&L Land, I can't recall a kitty whose caregiver followed TR ending up at the rainbow bridge due to overdose. There have been a few cases of symptomatic hypos and although my memory is a bit foggy I believe in each of those cases there was human error of some sort; kitty was either not properly monitored or in the hands of a pet sitter or other temporary caregiver that was unfamiliar or with FD and the power of insulin.

The TR protocol , although aggressive, has safety built in - the safety of home-testing and monitoring. The information testing provides will help you "Know thy Cat", the foundation of treatment. Combine that with a healthy respect for the power of insulin and you can be confident that you are doing all possible for your sugar-kitty.

As you build confidence the anxiety should subside. And one day, you might be surprised to see you have earned your BOS


Hey, if I did anyone can

 

[Wendy&Neko]

Another one piling on and saying that hypos are indeed scary. I shot Neko blind for 2 months on Caninsulin before a kindly locum vet showed me how to blood test and got me on Lantus. That shooting blind really scares me in hindsight. The best thing you can do to overcome your fear of hypo is to let Lucy get into lower numbers, when you are home to monitor of course, see what she does, and learn what it takes to bring her up. If it's honey, syrup or a hot fudge sundae (minus the chocolate), so be it. Learn your cat. Learn her patterns when in lower numbers and learn what it takes to control her blood sugar. I love shooting Neko in with a preshot of the 80's. Almost all the time it means a relaxing flat night (yeah, she always does it at PMPS ).

A couple of nights ago I was looking at some Think Tank threads and I found a comment by Steve and Jock (first kitty on Levemir) where he is commenting on a something by Kirsten (Roomp, co author of TR protocol). The quote was a light bulb moment for me:

I'm most interested in Kirsten's reply, because she brings up an important related issue -- that it's much easier (with Levemir or Lantus) to maintain a cat in euglycemic ranges (say, 75-160 or so), than to maintain them at some randomly chosen range that scares some people less. Blood sugar simply seems to get more stable (in the non-complicated kitties) when you keep it near normal.

So it's not at all a matter of tug-of-war between overdosing and underdosing. It's a matter of overcoming fear of the 'normal' blood sugar ranges, because those are the stable ones. People who see "68" and panic and lower the dose next time are doing themselves no favour, because it's way harder for most diabetic cats to get regulated between 150-250 than it is between 75-150, but you won't know this until you try. This is, as Kirsten says, because hyperglycemia stresses the pancreas and makes regulation hard.

I've tried it, it's true for me.

 

[Voula]

I hear you. When i do NOT give dweezil a furshot (ugh), and he gets his dose, i am always worried if he seems the least bit quiet that if i'm out for too long or if i go to bed that something will happen to him.

Each day i get home from work so relieved to see him alive. It is a constant fear. It's like a scary balance between keeping his levels slightly higher (no remission) but risking longer term damage, and trying for remission but living in fear...

Thank you for sharing how you feel too. I completely understand. You described how I feel so well and I hope with more time we can both relax a bit and worry less too.

 

[Voula]

I made progress facing my fear this morning as I gave Lucy her regular dose on time and it was the lowest AMPS I have dosed at.

 

[Wendy&Neko]

If you can, I'd get a +2 to get an indication what the cycle will look like.

 

[Voula]

Another one piling on and saying that hypos are indeed scary. I shot Neko blind for 2 months on Caninsulin before a kindly locum vet showed me how to blood test and got me on Lantus. That shooting blind really scares me in hindsight. The best thing you can do to overcome your fear of hypo is to let Lucy get into lower numbers, when you are home to monitor of course, see what she does, and learn what it takes to bring her up. If it's honey, syrup or a hot fudge sundae (minus the chocolate), so be it. Learn your cat. Learn her patterns when in lower numbers and learn what it takes to control her blood sugar. I love shooting Neko in with a preshot of the 80's. Almost all the time it means a relaxing flat night (yeah, she always does it at PMPS ).

A couple of nights ago I was looking at some Think Tank threads and I found a comment by Steve and Jock (first kitty on Levemir) where he is commenting on a something by Kirsten (Roomp, co author of TR protocol). The quote was a light bulb moment for me:

I've tried it, it's true for me.

Great post Wendy. Thank you so much. I was saying to Serryn recently how a vet nurse at the clinic we go to was dosing her cat with caninsulin with no home testing. Her cat has gone into remission after eight months on caninsulin but the only way she knew his dose needed lowering was several hypoglycemic episodes. Not a good way to do things. I would have a nervous breakdown giving insulin and not monitoring as it is anxiety provoking enough as it is with home glucose testing.

 

[Voula]

If you can, I'd get a +2 to get an indication what the cycle will look like.

I will be home all day so I will be testing regularly and at +2 too. Thank you.

 

[Voula]

Καλημέρα Βούλα

Am I correct in assuming you can read the above greeting?


I too agree with Eliz. A healthy respect for the power of insulin is a good thing.

I was thrown into the world of FD completely unaware that it even existed. In January of 2008, the heart of winter here, I took in Black Kitty, a local stray that I had been feeding outside for several months. Although in September of 2007 he was one very handsome Tom, by January he had become thin and frail and his eyes were weeping some sort of discharge. I knew he would not survive one more night. He let me pick him up and it was straight to the vet. He tested positive for FIV, had conjunctivitis and an upper respiratory infection. Blood was drawn sent out for analysis. The next morning I got the news that he was diabetic. My reaction was "What???"

I remember the anxiety of the first shot well. The dose was 1u Lantus. Besides the fear of being bitten, I was convinced that if I was successful at getting the insulin into him BK would immediately drop dead due to overdose. If someone would have told me then that in 7 months I would be using 2 types of insulin simultaneously and shooting some 45u per day I would have questioned their sanity.

Although extreme, our story is an example that fear and anxiety can be overcome.

Truthfully, in the 7 years I have been part of L&L Land, I can't recall a kitty whose caregiver followed TR ending up at the rainbow bridge due to overdose. There have been a few cases of symptomatic hypos and although my memory is a bit foggy I believe in each of those cases there was human error of some sort; kitty was either not properly monitored or in the hands of a pet sitter or other temporary caregiver that was unfamiliar or with FD and the power of insulin.

The TR protocol , although aggressive, has safety built in - the safety of home-testing and monitoring. The information testing provides will help you "Know thy Cat", the foundation of treatment. Combine that with a healthy respect for the power of insulin and you can be confident that you are doing all possible for your sugar-kitty.

As you build confidence the anxiety should subside. And one day, you might be surprised to see you have earned your BOS
View attachment 14006

Hey, if I did anyone can

Hi Sandy. Thank you for a great post and yes indeed I can read the Greek words you wrote . If only I knew how to reply in Greek using my iPad I would do it but good morning to you too . That BOS award seems like a distant dream but you never know I might get it one day too . I think it is so wonderful you took Black Kitty in. So many people have replied with such great words of wisdom and it is all helping me to make progress in overcoming my fears. I have much experience in overcoming fear in my life as for many years I suffered from agoraphobia and I am no longer housebound so I can do this too. Thank you again for your wonderful message.

 

[Jill & Alex (GA)]

Another one piling on and saying that hypos are indeed scary. I shot Neko blind for 2 months on Caninsulin before a kindly locum vet showed me how to blood test and got me on Lantus. That shooting blind really scares me in hindsight. The best thing you can do to overcome your fear of hypo is to let Lucy get into lower numbers, when you are home to monitor of course, see what she does, and learn what it takes to bring her up. If it's honey, syrup or a hot fudge sundae (minus the chocolate), so be it. Learn your cat. Learn her patterns when in lower numbers and learn what it takes to control her blood sugar. I love shooting Neko in with a preshot of the 80's. Almost all the time it means a relaxing flat night (yeah, she always does it at PMPS ).

A couple of nights ago I was looking at some Think Tank threads and I found a comment by Steve and Jock (first kitty on Levemir) where he is commenting on a something by Kirsten (Roomp, co author of TR protocol). The quote was a light bulb moment for me:

"I'm most interested in Kirsten's reply, because she brings up an important related issue -- that it's much easier (with Levemir or Lantus) to maintain a cat in euglycemic ranges (say, 75-160 or so), than to maintain them at some randomly chosen range that scares some people less. Blood sugar simply seems to get more stable (in the non-complicated kitties) when you keep it near normal. (emphasis mine)

So it's not at all a matter of tug-of-war between overdosing and underdosing. It's a matter of overcoming fear of the 'normal' blood sugar ranges, because those are the stable ones. People who see "68" and panic and lower the dose next time are doing themselves no favour, because it's way harder for most diabetic cats to get regulated between 150-250 than it is between 75-150, but you won't know this until you try. This is, as Kirsten says, because hyperglycemia stresses the pancreas and makes regulation hard."​

I've tried it, it's true for me.

While I agree and have always maintained a healthy respect for low numbers and the possibility of a hypoglycemic episode, I very much believe in Kirsten's statement which I put in bold above. So much so that when Alex fell out of remission after being OTJ for almost 3 years, I acted on these kinds of statements (like Kirsten's and Steve's). In 2009 a dental and 8 weeks of aggressive dosing took her off the juice once again.

If you look at the data in Alex's 2009 spreadsheet, you'll see those statements in action (click on the 2009 tab at the top of her spreadsheet). Don't be bothered or put out by the amount of times I tested Alex. I purposely tested Alex that often... more times than usual to illustrate what happens when you responsibly shoot low numbers.... "how to" obtain that long flat curve when using the long-acting insulins. The spreadsheet was simply created as a real time tool for others using Lantus or Levemir.

Unfortunately, some 5-6 months later Alex experienced acute episodes of liver and renal failure which threw her out of remission again in 2012. She remained on insulin the rest of her life. Even though she developed several other cormorbid conditions between 201o and 2014, my goal was to keep her as tightly regulated as possible because it became obvious quickly that she felt measurably better in "normal" numbers. Even when sick it was easier to maintain euglycemic ranges than a randomly chosen higher BG range.

 

[Voula]

Yes, after 5 years of the Sugar Dance we still worry about hypos and it has altered our lives. That said, lower numbers do not automatically mean hypo, but that it's time to take steps to prevent a hypo from happening. Tess has dropped into the 30s several times over the years, but has never showed any hypo symptoms. If you have to leave and Lucy is lower than you are comfortable with and honey is the only thing that brings her up, give her some honey. Learn how long it effects her too, honey or karo can wear off quickly. A timed feeder might be a good investment.

The best you can do is study your SS and learn Lucy's patterns. Getting a check at +10 or +11 gives you a heads up as to which way she is headed at shot time.

One good thing you have noted:
this probably means that her pancreas is recovering and producing some insulin on it's own! Normally after a meal is digested the pancreas detects the increased glucose in the blood and releases insulin to open the pathways into the cells. This will lower BG because the glucose is being used by the cells and is no longer in the blood. It's why we advise that if a cat on an OTJ trial has a slightly higher BG to test again 2 to 3 hours later. If the pancreas is producing insulin, the BG will be lower.

Thank you Ann. I have thought that Lucy's pancreas might be producing some insulin on some days because of the prolonged periods in blue numbers into the next cycle when I have stalled on giving an insulin dose. I need to do a little experimenting too with food that will raise Lucy's glucose levels when that is needed as the fancy feast gravy lovers which many people seem to use doesn't seem to work. But then again our fancy feast classics here in Australia are not all low carb whereas in the U.S. they seem to be. I have two timed feeders so we are well prepared with those. Thank you again for sharing your experience and your wisdom.

 

[Voula]

While I agree and have always maintained a healthy respect for low numbers and the possibility of a hypoglycemic episode, I very much believe in Kirsten's statement which I put in bold above. So much so that when Alex fell out of remission after being OTJ for almost 3 years, I acted on these kinds of statements (like Kirsten's and Steve's). In 2009 a dental and 8 weeks of aggressive dosing took her off the juice once again.

If you look at the data in Alex's 2009 spreadsheet, you'll see those statements in action (click on the 2009 tab at the top of her spreadsheet). Don't be bothered or put out by the amount of times I tested Alex. I purposely tested Alex that often... more times than usual to illustrate what happens when you responsibly shoot low numbers.... "how to" obtain that long flat curve when using the long-acting insulins. The spreadsheet was simply created as a real time tool for others using Lantus or Levemir.

Unfortunately, some 5-6 months later Alex experienced acute episodes of liver and renal failure which threw her out of remission again in 2012. She remained on insulin the rest of her life. Even though she developed several other cormorbid conditions between 201o and 2014, my goal was to keep her as tightly regulated as possible because it became obvious quickly that she felt measurably better in "normal" numbers. Even when sick it was easier to maintain euglycemic ranges than a randomly chosen higher BG range.

Thank you so much Jill. I will look at Alex's spreadsheet. I guess also it is a change of thinking when using long acting insulins because they do work a bit differently than the short acting insulins which are in and out in so many hours with no depot. I can certainly see that Lucy looks better when her glucose levels are lower as she seems brighter and more active too.

 

[Voula]

i think we all are afraid of a hypo. I won't leave the house before I'm sure Max is not going to go hypo. I've missed out on lots by being that way. I am not one for giving dosing advice but I do wonder if you would be better with the go slow approach which if I understand correctly you don't increase as quickly. I wonder if you can find a dose that keeps Voula in blue that you can give consistently twice a day without having to skip doses if she would level out to the point that then you could increase? I don't know if this makes sense or if it is a good idea but just thought I would throw it out for others to comment.

Thank you. This makes a lot of sense and indeed after giving Lucy her insulin this morning with a blue AMPS it will be very interesting to see what happens today in this cycle and at tonight's PMPS. If I can dose again tonight with another blue PMPS I will hold off on increasing the dose for a few days to see what happens when I give doses on time and don't wait for the glucose levels to rise. I also don't feel confident to give dosing advice but I really appreciate your message.

 

[Voula]

If you can, I'd get a +2 to get an indication what the cycle will look like.

I did a +2 and we have had a drop from 8.9/160 to 5.8/104.

 

[Voula]

Hi Voula,

My cat has been on insulin for 8 years now, and the idea of hypoglycemia can still sometimes frighten me.
Bertie has had 3 hypos, though hasn't had one for a few years now (touch wood/anti-jinx). And fortunately I was at home for each of those episodes.

In my view, the best general defence against hypoglycemia is gathering data and getting to know the patterns of how the insulin works in the kitty's body. I've learned that a test at +2 usually gives me an indication of what's going to happen later in my cat's insulin cycle. I can usually get a good idea of how much and how fast his blood glucose might drop.
But even when we're familiar with the typical patterns there are still all sorts of things we can't predict: Maybe the kitty is off his food. Maybe he throws up. Maybe his pancreas decides to do some more work that day...

It is difficult when we have to go out and won't be able to check the blood glucose as much as we'd like; especially if the preshot level was lower than normal. Occasionally I've skipped shots in this instance. More often I've given a reduced dose (even a teensy token dose at times so he has some insulin in his system).

If I see, after I've given the shot, that my cat's blood glucose is falling faster/further than I'd like, then I may make sure he eats something that I know will raise his blood glucose before I go out.
My experience of hypo has made me cautious; and I really do believe that, as the FDMB saying goes (regarding blood glucose), "It's better to be high for a day than too low for a minute".
But, as much as we might like to, we can't control every situation. Sometimes we just have to do our best and trust that things will be OK. And they usually are...

Forunately, hypoglycemia is actually a pretty rare occurrence in cats that are hometested. Many, many cats never experience hypo.
I think though that a little bit of fear in regard to hypo is no bad thing (as long as it doesn't consume you and make you miserable). That little bit of fear will make you careful. And you may be far better off than those who have a more casual attitude to hypo.

Eliz

Thank you Eliz. The vet said if I was very anxious about a lower than usual pre-dose number I could give a small dose of insulin or skip the dose but she prefers I give a small dose so Lucy still has some insulin during the day while I am out. I gave a smaller dose the other day when I would be out all day as I was anxious.

 

[Marje and Gracie]

Voula

Lots of good replies to help you sort through this emotion which we all share and if someone doesn't, they need to think about it all again. Every person shooting insulin into their cat should have a more than healthy respect and fear of hypo; it keeps us on our toes.

When you ask why she would still keep going down when you feed her, it depends on where she is during the cycle and what's happening. Is she clearing a bounce? Is she onsetting? When they have bounced and are clearing, it can be a very active cycle and so what might normally work if they are coming down slowly, does not work if they are coming down fast. This is where knowing your kitty really comes into play.

Study her SS and try to determine when she onsets, when her nadir might be (it can change), and how much duration does she get from a shot (also can change). If you need help with this, let us know. We're always happy to help in that regard. Then note how she reacts to food when she's flat, when she's clearing a bounce, when she onsets. I bet it's different.

For example, I know if Gracie (and this is just Gracie...I'm not applying it to any other cat) drops more than 50 mg/dL an hour, I need to slow her down with higher carb food or, depending on where she is BG wise, sometimes a drop of karo. If I test her at PS and then at +2 and she's down, for example 70 mg/dL, I don't assume that she came down 35 mg/dL an hour. I feed her and retest her in either 30 mins or one hour, depending on how low she is, so i can see exactly how fast she's dropping. It's more like an art than a science in figuring out your own cat and how she responds to food. We study Gracie's SS a lot and we will see a similar situation to the one at hand and then apply what we learned from the previous situation. We have gotten good, for the most part, of knowing what to feed based on where she is in the cycle and how fast she's coming down. Although there are times when we still overcarb her occasionally because she did something different but overcarbing is ok because you know the number is going to go up but will come down again at some point. And there are times that what worked before, doesn't, and she drops more but we are testing frequently.

As Sandy said, and I haven't been around here as long as she has, but I can't recall a kitty that has been following the TR protocol and where the caregiver was monitoring that the kitty had a symptomatic hypo. And if you need to give Lucy honey or syrup to bring her numbers up...do it. Just be sure to follow it with some food to try and hold the numbers up a little bit.

 

[julie & punkin (ga)]

I wanted to just add that the first thing I did every morning while punkin was diabetic was to open the door to our downstairs where he slept, and breathe a sigh of relief that he was still alive. I don't think i'm the only one who had that thought every morning.

One other thought - there are differences in how high carb people's high carb is. At one point punkin kept testing in the 40's when we were new, and the person helping me said to not let him surf in the 40's. I replied that I was TRYING to get him out of the 40's and was following the directions to give him a tsp of gravy and retest in a bit. As we talked it came out that our high carb was 16% and the experienced person helping me said she always used a HC over 25%. That makes a difference. If you're getting a response from honey, but not your gravy, double-check and see how many carbs that food is. Nothing wrong with using honey. You can add it to some regular food to help sustain the numbers if you need to.

 

[Voula]

Voula

Lots of good replies to help you sort through this emotion which we all share and if someone doesn't, they need to think about it all again. Every person shooting insulin into their cat should have a more than healthy respect and fear of hypo; it keeps us on our toes.

When you ask why she would still keep going down when you feed her, it depends on where she is during the cycle and what's happening. Is she clearing a bounce? Is she onsetting? When they have bounced and are clearing, it can be a very active cycle and so what might normally work if they are coming down slowly, does not work if they are coming down fast. This is where knowing your kitty really comes into play.

Study her SS and try to determine when she onsets, when her nadir might be (it can change), and how much duration does she get from a shot (also can change). If you need help with this, let us know. We're always happy to help in that regard. Then note how she reacts to food when she's flat, when she's clearing a bounce, when she onsets. I bet it's different.

For example, I know if Gracie (and this is just Gracie...I'm not applying it to any other cat) drops more than 50 mg/dL an hour, I need to slow her down with higher carb food or, depending on where she is BG wise, sometimes a drop of karo. If I test her at PS and then at +2 and she's down, for example 70 mg/dL, I don't assume that she came down 35 mg/dL an hour. I feed her and retest her in either 30 mins or one hour, depending on how low she is, so i can see exactly how fast she's dropping. It's more like an art than a science in figuring out your own cat and how she responds to food. We study Gracie's SS a lot and we will see a similar situation to the one at hand and then apply what we learned from the previous situation. We have gotten good, for the most part, of knowing what to feed based on where she is in the cycle and how fast she's coming down. Although there are times when we still overcarb her occasionally because she did something different but overcarbing is ok because you know the number is going to go up but will come down again at some point. And there are times that what worked before, doesn't, and she drops more but we are testing frequently.

As Sandy said, and I haven't been around here as long as she has, but I can't recall a kitty that has been following the TR protocol and where the caregiver was monitoring that the kitty had a symptomatic hypo. And if you need to give Lucy honey or syrup to bring her numbers up...do it. Just be sure to follow it with some food to try and hold the numbers up a little bit.

Thank you so much Marje for your great post too. There is so much to learn and it feels like we are just beginning at the moment though Lucy was diagnosed late last year because we really haven't had many low glucose readings to gain experience as to what to do I feel like we are at a new phase of learning now.

 

[Voula]

I wanted to just add that the first thing I did every morning while punkin was diabetic was to open the door to our downstairs where he slept, and breathe a sigh of relief that he was still alive. I don't think i'm the only one who had that thought every morning.

One other thought - there are differences in how high carb people's high carb is. At one point punkin kept testing in the 40's when we were new, and the person helping me said to not let him surf in the 40's. I replied that I was TRYING to get him out of the 40's and was following the directions to give him a tsp of gravy and retest in a bit. As we talked it came out that our high carb was 16% and the experienced person helping me said she always used a HC over 25%. That makes a difference. If you're getting a response from honey, but not your gravy, double-check and see how many carbs that food is. Nothing wrong with using honey. You can add it to some regular food to help sustain the numbers if you need to.

Hi Julie. A very good point. I assume the fancy feast gravy lovers is high in carbs because I read on the board that it is. But I know the fancy feast classics we get here in Australia are not all low carb like they seem to be in the U.S. When I used a carb calculator the carbs in the fancy feast gravy lovers did not seem that high. Today I tried Whiskas canned food in gravy and possibly this is higher carb as it seems to have had a little effect but then it may not have as the glucose level might have come up a bit regardless of the food. I will call the company that makes Whiskas and get some more information as the label on the can only gives protein and fat percentages so I can't work out the carb level in the food. I just presumed by the ingredients and the fact it has gravy that it probably is high carb food.

 

[julie & punkin (ga)]

You can always increase the carbs in anything - low carb or gravy, but adding a few drops of honey, corn syrup, or maple syrup.

I had thought that punkin wasn't very carb-sensitive because other people gave a teaspoon of gravy (per the directions on the Low Numbers sticky) and I was giving a tablespoon and thinking it wasn't moving much. But when I had a 26% carb formula, a very small amount did move him, just like any other cat.

 

[Melanie and Smokey]

I don't think any of us get not afraid of it. Sometimes we get enough information that we are able to work through that fear. Even with ChrisFarley, our 3rd diabetic, we'd get nervous once in a while and pull back. Julie, Marje, and Jill were often around to give me a gentle nudge back on track, or subtly tell me to pull my big girl pants up I think and really focus on the process and understand the tools.

I don't understand why glucose levels drop after eating.

This can actually be a sign of a good thing! When diabetic cats first start out, food raises them pretty easily, we are adjusting food to try not to get that raise. As the pancreas heals, it starts doing what it is supposed to do releasing insulin and drops from food can be a sign we have a functioning pancreas!

 

[Voula]

I don't think any of us get not afraid of it. Sometimes we get enough information that we are able to work through that fear. Even with ChrisFarley, our 3rd diabetic, we'd get nervous once in a while and pull back. Julie, Marje, and Jill were often around to give me a gentle nudge back on track, or subtly tell me to pull my big girl pants up I think and really focus on the process and understand the tools.

This can actually be a sign of a good thing! When diabetic cats first start out, food raises them pretty easily, we are adjusting food to try not to get that raise. As the pancreas heals, it starts doing what it is supposed to do releasing insulin and drops from food can be a sign we have a functioning pancreas!

Thank you Melanie. It is good to know that so many people understand how anxiety provoking it can be worrying about hypoglycemia but also really good to know that most cats who are monitored do really well and have no issues. I learnt a lot from today from dosing at a lower PMPS reading and from seeing Lucy's glucose levels drop and being able to manage that. I even went out for an hour or so after I was sure her glucose was rising again. A few people have said the same about glucose levels dropping after food and that being a sign of a functioning pancreas and that is a very hopeful and positive thing. Thank you again.

 

[Sienne and Gabby (GA)]

Voula:

Anxiety can either be paralyzing or it can give you a healthy respect for a situation. We used to have a fire chief who posted until her kitty went OTJ. I have no doubt that Ruth understood that the rest of us were terrified by fire -- she had a healthy respect for a fire. Her attitude was born out by knowledge and training and experience. Knowledge is power. Training and experience build confidence. There's a huge amount of information that all of us need to be familiar with and it's information not just about FD but about how each of our cats responds to insulin. This isn't a "one size fits all" process. And to complicate the "every cat is different" (ECID) maxim, most cats do NOT like to be predictable!

Hypoglycemia is an understandable fear. As others have pointed out, there is a distinction between a symptomatic hypoglycemic episode and low numbers. Sandy is one of our longest term members and like her, in my 5+ years here, the only times i've encountered a kitty with a legitimate hypoglycemic episode was due to a caregiver's (or someone filling in for the caregiver) making a mistake. That said, the cat survived. There have also been caregivers who have accidentally given their cat an overdose (e.g., one situation comes to mind when the person dosed 5u vs. 0.5u), realized the mistake, posted, and we were able to circumvent a crisis.

One fact I want to underscore. The TR protocol is based on peer reviewed research that had to be approved by a university's research ethics committee (i.e., an institutional review board). If the research put an animal at risk, it would not be approved and the investigator would be prohibited from using university resources for the research and the research couldn't be published. The protocol allows a cat's BG numbers to drop into the 40s to qualify for a dose reduction. While I don't think any of us would encourage a member to have their cat's BG numbers sit in the 40s for hours and hours, the fact that you monitor and are observant and know how to use food to steer the curve allows you to get the dose reduction and keep your cat safe.

There is a process of getting comfortable with shooting low numbers and gaining confidence in your ability to steer your cat out of low numbers. Look at lots and lots of spreadsheets. Look at Gabby's or Gracie's. You'll see that both Marje and I have had our cats drop into truly low numbers -- not for long, though. We know what to do and can trust our instincts and our kitty because we have data demonstrating how our cats respond to HC food. Don't let your fear of low numbers interfere with your wanting to get your cat either well regulated or into remission.

 

[Voula]

Thank you Sienne. I faced my fear today and gave Lucy her insulin without waiting for a rise in her glucose and she got into green numbers which panicked me a bit but it was a learning experience. I have been studying spreadsheets and this is helping me to gain confidence. Today's experience has also built some confidence. Your message along with the other messages in this discussion has been really great and so helpful and reassuring too.

 

[monty_dweezil (GA)]

Hey Voula, you say Lucy has fancy feast classics? Which ones do you give her? There seem to be only 2 that don't list cereals here in Australia.

I think finally we're building up a bit of a selection of reliable low carb foods for Dweezil. Ziwipeak, Nature's Gift kangaroo, 2 Wellness Core flavours, 2 Whiskas loaf types, Fancy Feast cod, sole & shrimp, and for treats, dried liver and 100% tuna loin.

 

[Voula]

Hey Voula, you say Lucy has fancy feast classics? Which ones do you give her? There seem to be only 2 that don't list cereals here in Australia.

I think finally we're building up a bit of a selection of reliable low carb foods for Dweezil. Ziwipeak, Nature's Gift kangaroo, 2 Wellness Core flavours, 2 Whiskas loaf types, Fancy Feast cod, sole & shrimp, and for treats, dried liver and 100% tuna loin.

I feed Lucy the fancy feast cod, sole and shrimp, the ocean whitefish and tuna, the turkey kitten variety and the fish kitten variety. I am trying not to feed so much fish so I recently started feeding the Whiskas 8+ loaf varieties in the pouches. I also feed any of the Whiskas canned loaf varieties. I occasionally also feed the Dine Desire varieties but they are not a complete balanced food and the thickeners in those vary and possibly some of those are not suitable as sometimes I think possibly some of those have caused increased glucose levels and occasionally I also feed the Snappy Tom Ultimates too and they seem fine. As a special treat because Lucy loves the fancy feast grilled varieties so much I do give her a teaspoon or two of those even though they have cereals in them and they don't seem to affect Lucy's glucose levels in small amounts. But mostly I feed the fancy feast varieties I mentioned and the Whiskas loaf in pouches. I bought the Nature's gift food a few times but they smell terrible and the smell put me off them. I don't know if they were off. It seems you have found a few different suitable foods which is good.

 

[monty_dweezil (GA)]

Oh good! I'm going to try those other FF ones again too now. Monty's been eating them and also the Ultimates (non-rice ones) but i think they should be safe for Dweezil too.

Today we bought a heap of the Weruva Cats in the Kitchen brand. All very low carb. Woo hoo!

That's weird about the Nature's Gift ones smelling so bad! The kangaroo ones we've tried smell quite nice! (For cat food. Lol)