Just got back from the Vet...

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Under normal circumstances, it is NOT necessary to stay up and feed a cat every couple of hours. That was a special occasion last night... what we lovingly call a PJ party.:D

Most of us feed several small meals throughout the day. Some do 4 times per day, some do 6 times per day. Much of that is what works for your schedule. I do 6 feedings per day with a meal at each shot time and then 2 small snacks in between during each 12 hour period.

If you can get one non-food influenced reading and one that is food influenced during the day today, that should indicate if Barry is holding good low numbers or still needs insulin. I'm sure you want to be able to get a good night's sleep tonight so if I were you, if he does need to go back on some insulin (fingers crossed he doesn't), I'd start fresh tomorrow morning. It's clear if he does need more insulin, the dose needs to be reduced! And in his case, I'd probably reduce more than our normal reduction amounts. Let's see what the readings are today and then we can help you decide next steps.:)
 
We were lounging in bed when Barry hopped up and was being adorably kitten-ish, playing with the blankets and "attacking" my husband's hand and arm. He started to mellow out so I went and got the new Freestyle Lite test kit that I got last night. Thanks to all the photo and video instructions I read this morning it went a bit smoother, I think I finally understand the "sweet spot". Unfortunately the meter gave a reading of 1.5 which seemed shockingly low considering his behaviour and energy level. We tried putting a Freestyle strip in the AlphaTrak meter but there wasn't enough blood left on his ear for a reading. He started to get quite squirmy at that point and we didn't want to restrain him, we're hoping to train him to enjoy testing and pinning him down for another sample seemed counterproductive. I gave him treats after, even though he'd moved to another room I'm hoping he will associate the treats with the testing. Its been about 3 hrs now since he ate so we gave him some food. We will try testing again in an hour or so to get a post food reading.
 
If keeping Barry in place for testing is an issue, once you get a blood bead to appear, catch it on a clean finger nail and test from there. Sometimes holding them down is the problem far more so than the testing itself.

I agree with Mogs....better too high than too low but I can't imagine Barry being that low this long after his last shot about 27 hours ago?!
 
Yeah, his symptoms don't match at all with low blood sugar. I think it was a low reading that was a fluke. We fed him a little while ago so we will try another test in a bit after he's digested.

Also, I work Mon-Fri, 8-4, and right now Stace is off work so we can do multiple feedings. When she goes back to work though, what should we do? 4 times a day could be hard depending on what her schedule is.
 
If I'm doing the math correctly after not enough sleep it had actually been over 38 hours since his last dose of Lantus when we did that test. And that was also after he'd been given a mix of wet and dry food (about a tbsp of each) every 2 hours for about 12 hours. I'm obviously no expert but that seems very strange. What are we doing wrong?
Edit: he also still seems kind of hungry, he follows us around the kitchen meowing. Should we give him larger meals?
 
Oh dear! I guess I need more coffee 'cause my fingers haven't woke up yet and apparently neither has my brain. Meant to type 37! :rolleyes::oops:

It can take a couple of days to diminish the shed of insulin in the body but the amount that should be left now, certainly shouldn't be causing that low a number in and of itself. If he is running at normal numbers on his own, I suppose what's left of the shed could be taking him down a little more but cat's have a remarkable defence system that will click in if the body perceives BG going too low. In Barry's case, his defense system couldn't override the effects of the Lantus which is why he had the symptomatic hypo yesterday. It could be that his defense system effectively got used up yesterday and hasn't been replenished yet so feeding him some extra if he wants it is probably a good idea until this puzzle gets figured out.

You are not doing anything wrong. Cats are cats and it would be sooo much easier if they could tell us how they are feeling. We unfortunately are left guessing and using the few tools we have to figure things out. You are doing great. Don't start doubting yourselves. :D

When you are out all day, you can freeze some canned food and leave it out to thaw in a bowl for eating later in the day. Some folks have automated feeders that have a compartment for an icepack and leave food out that way.
 
tempstace said:
he also still seems kind of hungry, he follows us around the kitchen meowing.
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Test as soon as you can to be on the safe side.

BTW are you using anything to support Barry's ear when you're doing the poke? If not try the following:

1. Warm the ear.

2. Wrap a 1" strip of folded kitchen paper around your index finger then wrap the ear around the finger in a similar fashion.

3. Hold the ear and paper support in place with light-firm pressure from your thumb and middle finger. (Helps reduce head movements, too.)

4. Poke to draw blood sample.


Mogs
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So we did the ear poke as you guys suggested. SO MUCH EASIER!!!

Anyway, we got a test with the Freestyle Lite strips in the Cat Tester. Came back at 3.3. This was maybe 1 hour and 15 minutes post feeding. Should we give a bit of corn syrup, or wait? When we test again, when should we do it?
 
When in doubt (unusual test number), re-test.

Also note that glucometers are not super precise testing instruments. In the US, they are allowed to read +/- 20% of what a lab would get. There is more detail on that in my signature link on meters and reference values.
 
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TLantMagnus said:
Came back at 3.3. This was maybe 1 hour and 15 minutes post feeding. Should we give a bit of corn syrup, or wait? When we test again, when should we do it?
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A tad on the low side if it were an Alphatrak strip (Linda will be able to better guide you on using the Freestyle strips).

Is Barry still hungry?



ETA - my vet gave me 3.9-8.3mmol/L as the normal blood glucose reference range for a non-diabetic cat as measured on an Alphatrak 2 meter (using Alphatrak test strips).
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That reading taking the use of FS strips in the pet meter into consideration which stand a 25% chance of being completely accurate in the pet meter is still really low. Low alert on the pet meter is 3.6mmol. So with our 15% variance allowance and the FS strips he's right on the edge or still a bit low. Did you give him any honey back when you got the reading of 1.7 earlier this AM?

I'd be inclined to test again in about 30 minutes and see where he is at without giving anything else to eat now. That will tell us if he is rising or falling. Obviously should he show any symptoms of being off, between now and then give him some syrup/honey to boost him immediately.
 
When we got the first reading we just gave him some Boreal canned, with diabetic dry.

After this test we have him some Boreal canned, a bit of corn syrup and a high fiber cat food which is a gastro-intestinal response food. Two of our cats are on special foods so we have a variety of dry to feed.
 
@MrWorfMen's Mom -

With the continuing low numbers I am wondering whether it could be down to the pancreas kicking in on top of the only partially-drained (and previously overfilled) depot - and also possible increased insulin sensitivity after the hypo?

I need to scoot off (really poorly at the mo) but it would be worth keeping an eye on Barry's postprandial numbers; if the pancreas is kicking in it may drop his BG levels again in the hours after a meal (especially if feeding low or very low carb).



Mogs
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@Critter Mom I'll keep checking in to keep an eye on what's happening here. You go get some rest and look after Saoirse. I am wondering the same thing. If his pancreas has started working along with the remaining depot which was obviously overfilled and his natural defence system was pooped out, we have one extended period of monitoring/steering needed to get this guy back to his "normal". Hopefully this is a good sign of remission or very close to.

@TLantMagnus there is no way for you to check his pancreas other than his BG which is the indicator we are concerned with here.:)
 
TLantMagnus said:
Sorry, didn't get the msg to retest till after we fed him. :(
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No worries. When exactly did you last feed him? We need to keep track here so we know what the numbers are telling us. As BJM says, glucose levels rise in the first couple of hours after eating then begin to drop again. We need to get a reading when he is at his highest after eating and then a number when he has gone down from not having food to figure out if he needs insulin at all. Right now he obviously doesn't need insulin but we need to make sure he is not diving again to dangerous numbers so knowing when he last ate along with readings is key.
 
Following on from BJ's post above, things are currently a bit trickier in Barry's case because the depot will not yet have been depleted. He may not be getting injections at the moment but he will still be 'receiving insulin' from the depot.

You got a number on the low side 75 minutes after eating earlier on. I'd therefore suggest you test earlier than 2 hours after feeding (and, needless to say, test immediately if anything seems 'off'). Other members may have better suggestions.

@MrWorfMen's Mom - Good to know you're on the case, Linda. :)

C'mon, Barry! :)


Mogs
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A silicone mini muffin pan is so easy to use to make little hockey pucks of frozen food because they pop out so easily after they are frozen. I always leave them out for Radar to eat "later" whenever I need to be away for a few hours and for overnight snacks.
 
@Critter Mom we got the one test 1 hour 15 minutes post eating of 3.3 which was low and I expected to be higher. I wanted to wait out the full two hours for another test but I think Barry got fed again. So I'm thinking if we test 30 minutes after food to see where he's gone this time and then depending on that reading maybe another test an hour later provided he's at a safe number. That should give a view of what food is doing for him right now. And I thought Menace was nuts the other day with low numbers for 22 hours straight! Barry's definitely knocked Menace out of running for the Guinness Book! :woot:
 
TLantMagnus said:
How do we check for his pancreas function?
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Not easily if you are not a vet with a fancy lab! What people are talking about is whether the pancreas has regained normal or near normal functioning and the body is producing its own insulin. If the pancreas is recovering then any injected insulin still remaining will be acting as well as the body's own insulin to reduce the blood sugar level and it may well drop too low. Once the injected insulin has run out of steam the body will then rely on its own insulin and your blood sugar readings will help to determine how well it does this once he is off insulin, if they stay in the normal range - great you have enough pancreatic function to not need any extra insulin. If they run a bit higher than normal range then he may well still need some insulin but at a dose which is just big enough to help out the body's own insulin and not push the sugars too low. The body auto-regulates its own insulin production but add an injection into the mix and you can't turn off the injection as the body can with the pancreas.
 
Sorry to leave you all hanging! I'm somewhat embarrassed to say that I had to get out of the house for a while. The stress of all this and the lack of sleep was making my back problems get worse and altogether I was an emotional mess, I needed a break so I could think clearly so I went to the local pool I joined for rehab for my back. Barry's dad was still home to monitor and feed. Barry ate at 1:30 and again at 4:00, it's now 4:25 and we are going to try a BG test. Will post results soon.
 
It looks like as a team we are getting better at the BG testing!
So about 30 minutes ago Barry ate a mix of Boreal wet food & a tbsp of high fibre kibble with 3/4 of a tsp of corn syrup as "insurance". We just tested and got a big enough blood droplet to test with both the AlphaTrak meter and the Freestyle Lite meter. AlphaTrak gave us a reading of 6.1 & Freestyle gave us a reading of 4.6.
If I understand correctly, we should test again at 2 hours post food to see what his numbers are doing. If anyone thinks we should test sooner than that don't hesitate to let us know.
 
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Ok thank goodness! Good to know Barry is doing OK and you too.

A readings of 6.1 (pet) and 4.6 (human) are good and safe but suggest that Barry still needs some watching especially if you gave him more corn syrup and not just food. I'd get another reading in a half hour which will be about 2 hours after he last ate to see if he is holding, rising or dropping. I'm a little concerned that the corn syrup may be giving a us a false sense of where his numbers really are right now.
 
At 5:30 Barry was looking relaxed and dozy and his ears were warm and I was too impatient to wait for the 2 hour mark. I also wanted to see if I was capable of testing solo. Everything went very well up until my attempt to get the blood on the test strip and he decided that would be the ideal moment to climb off of my lap and shake his head. :arghh: I tried to massage a bit more blood out and "scraped" a sample on to the strip. The reading came back as 25.9! This seemed really really unlikely and I was sure the polysporin on his ear may have had something to do with it. Following previous advice, when unsure, re-test! This time I got back up and we got a reading of 6.2 which seems much much more reasonable! This was at 1 hr and 45 minutes after eating.
He's now gone from calm and dozy to full on crazy kitten mode, chasing one of our other cats, running up and down the stairs, and trying to climb on to the shelves on the wall. :cat:
Now the questions I've got are:
How soon do we test again? When should he eat again? How much food should he have? And last but not least - will we have to do overnight feedings again? Fingers crossed that I get to sleep through the night!
 
To be honest, with the numbers not coming up much yet given all the food and corn syrup, I think there is a possibility you may need to keep an eye on him through tonight. The good news is the longer this goes on, the more likely it is that his pancreas may be pumping out "normal" amounts of insulin. The bad news is that the depot can take several cycles to drain completely and right now I am concerned that he could again get to critical levels if you don't stay ahead of the insulin. For now he is holding at essentially the same level he was at 30 minutes post food so he had already reached his peak food spike at 30 minutes post meal or he could be starting to drop again.

Now we need to know what his BG looks like without food influence. I'd get another reading in one hour and don't give him any food, syrup, treats between now and the next test. Depending on where he is in a hour will determine next moves.

Again, should he start acting odd at all between now and the next test, take a reading immediately and if he is below 3.6 on the pet meter or 2.8 on the human meter, give him more syrup and food and post the numbers and what was given here. I'll keep checking periodically but I expect he'll be fine for the hour.
 
It's been just over an hour since we last tested and almost 3 hrs since he'd eaten. We got a reading of 4.7, which is dropping but still in a good range. We did have to entice him with a single treat to come to us to be tested and he had a few treats an hour ago when we last tested. He's still having bursts of energy but is fairly calm on the whole, following us around the kitchen a bit and checking to see what the other cats are up to, so basically acting like a normal cat which is lovely to see.
Should we feed him now or wait until, say 3.5 or 4 hrs?
 
No please do not feed him again now. I am really concerned that he is going to get filled up and not eat when he really needs to. Let's get another test in 30 minutes and see how much more he has dropped. Just to confirm, was that reading on the pet meter or the human meter because that does make a difference to how we judge what he is up to?
 
It was the AlphaTrak with the Freestyle strips. We now plan to have that as our standard meter and will only use the Freestyle meter as a back up if needed for some reason.
Since posting he had another burst of full-on crazy kitten mode, running all over the house. So cute to see him so happy!
We will test again at 30 minutes. If he's holding steady do we wait a bit longer to feed him? I assume that if it's still dropping he'll need to eat.
 
Yes, if he is holding, then I would put off feeding again, get another test 30 minutes after the last test and so on. You are going to have to keep testing to ensure he doesn't drop too far. I'd like you to be able to keep him at a safe level without having to use syrup all the time because that provides a quick boost but doesn;t last long so let's take baby steps here till we figure this out.
 
We weren't intending to make a habit of adding the corn syrup, we did it for his 2 feedings this afternoon because I was going to be out of the house and we wouldn't be able to test his sugar. We thought it safest for him to get his numbers up on the higher side.
We've just tested again and it was 4.6 so only a 0.1 drop from 35 minutes ago. It's now been 3.5 hours since he ate. We rewarded him with a single treat even though he wasn't on his best behaviour and I had to resort to the trick of putting the droplet on my fingernail before he got away. I was certainly grateful to have that trick in my arsenal though!!
 
I fully understand using the syrup in this situation when you were going out and that was a good idea but now that you are home, we need to see what he does on food alone. He's holding steady so let's wait another hour and test again. If he is holding then, without any more food I think it would be safe to say he is starting to head out of the woods but that doesn't mean he couldn't drop again so he'll still need monitoring although maybe not quite so intense as last night. Let's see what the next test says.
 
Barry is becoming a champ at testing and we just got a 4.3, a drop of only 0.3 since one hour ago. It's now been 4.5 hours since he ate, would it be safe to now give him dinner? The other 4 cats are also hoping it's almost dinner time. If we can feed him now, or soon, any recommendations as to how much and what type of food would be appreciated- i.e. blend of wet and dry and amounts. Thanks in advance for any advice!
 
Ok he is sitting at a most beautiful number right now and seems to be holding pretty steady. :D I'd give him canned food only this time (no kibble of any sort) and let's test again an hour after his meal to see how that works. We don't want to starve him and certainly don't want the rest of the crew starting a riot! :woot: Just please try to keep him out of any kibble if you give that to the other cats so we can see how Barry is doing without extra boosting of his BG.

As to amounts, are you going to feed him Boreal or do you have any other canned food? What does Barry weigh? Is he at an ideal weight, too thin or too fat? We'd need to figure out how many calories he needs to be precise about this. If it's the small Boreal cans, I'd give him a half can and if he is still hungry then another tbsp. or so and see if that satisfies him for now. This is tricky because until we know he is continuing to hold steady on the canned food, I don't want to have him so full he won't eat later if needed.
 
He weighs 11.6 pounds and to my eye I think he's a little bit thin but I might not be the best judge as our other cats are a bit chubby. He has never ever turned down food so I very much doubt that he would get too full to eat later, especially because he keeps going in to crazy kitten mode and running around. Currently all we have is the large cans of Boreal but we will be happy to switch to any recommended food, it might take a couple days though because stores will probably be closed tomorrow for the holiday.
So we'll feed everyone now, comparing an empty small size can of the diabetic food to the size of the large can of Boreal my math came out to 1/5 of the large can for Barry's dinner. He's happily munching now, we'll test at about 10:00 and keep you all posted!
 
Critter Mom said:
Here's a body condition chart to help you assess Barry's weight:

http://research.unc.edu/files/2012/11/CCM3_032386.pdf


Mogs
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I've seen that chart before, we think he's just under being a 5.

We did his one hour post food test (Am I supposed to refer to this as his +1 reading?) and he's at 4.6, which is a great sign, right? I imagine we should check again in an hour or maybe an hour and a half.
What should be our plan for over night? How long of a gap between feedings? Or does that depend on the next reading to see how his numbers hold?
 
That's an excellent number but I'm a little surprised he hasn't gone up at least a little bit. The Boreal is only about 1% carbs so that may explain it. If he were mine, I'd get another test in an hour to be absolutely sure he is holding. If he is holding, then I'd leave some food out and set the alarm to test again in 3 or 4 hours. If he keeps holding at that number or a bit higher, he is safe but if you get a lower number then more intense monitoring may be needed. Definitely keep the syrup and kibble out of the picture unless he drops below 3.6 on the pet meter. This is the only way you are going to know for sure he is holding good numbers all by himself.
 
His +2 reading is 5.2 so it's gone up a little bit! Yay! He also seems happy to come to us at testing time, we've switched from actual treats to giving him a couple kibbles of dry Boreal because it's probably lower carb than the treats but he seems just as happy with those as his "reward".
Unfortunately leaving food out for him isn't a viable plan because the other 4 cats would likely help him eat it ;) Matt was planning to stay up for a while anyway so he's going to give him a half sized meal (Boreal wet only) at around 1:00 and then we'll set an alarm for a couple hours after that to get up and test his BG. If his numbers are good then should he go without food until morning? Or should we do another half sized meal during the night? I'm happy to get up to check on him but not having to feed him every 2 hours is a nice improvement :)
Also, he has continued to be incredibly playful through the evening, entertaining us with his antics.
 
Wonderful news and great number! :DIt's wonderful to see them feeling so much better!

So if Matt is planning to stay up till 1am, if he can test by himself, get him to test Barry and then give Barry another meal just before going to bed. If Barry is still in the same range of numbers at that time, I'd set an alarm for 4 hours later and if he is still holding then, you can give him a little food and I think you can safely call this excitement history. I think at this point you know what to do should you happen to get an unsafe reading, but I think that is a long shot.

If Barry he continues to hold through the night with no further low or high readings, tomorrow will be day 2 of his OTJ trial. You can officially declare him in remission if he can maintain normal numbers for a period of 14 consecutive days. During those days, you will need to continue to test him periodically but no more PJ parties. I'll have to find the sticky for the OTJ trial instructions and post them for you later. I'm about to hit the sack now and don't have it handy.

I just checked the Boreal website again and it appears they have now added taurine to the canned food so it is fine for a steady diet if that is what Barry likes. . When I checked it out a year or so ago, it was missing that ingredient. My bad...I should have checked again before assuming! Other good options are Fancy Feast Classics and Friskies and some PC brands. Below is link to a spreadsheet one of our Canadian members put together of some foods that are appropriate for our sugar babies.
https://docs.google.com/spreadsheet...0KlRA2ZVTk_tYNVRaoG_3Dfy64/edit#gid=964479244

Can we get you to update both your signatures with a bit more information tomorrow like the date of Barry's diagnosis, any other health concerns/medications, his age, diet (you can just put the Boreal in now and change it later if you decide on something else), indicate you are in Canada so folks can give you applicable info when needed, and if you'd like to give us your names, we like to know what to call the kitty's parents! :). If Barry does start rising again and insulin needs to be restarted, this information will make it easier for everyone to assist you and you won't keep getting asked the same questions repeatedly.

The other bit of homework you should tackle tomorrow is the spreadsheet. The spreadsheet you set up is for use with a human meter. You should be using the one for pet meters if that is the meter you are going to stick with going forward. If you can do that tomorrow, it will give you a way to track his OTJ trial readings. And should insulin need to be resumed, it will give us data to review so we can advice you in the best way possible.

With that, I will wish all of you sweet dreams! Hope everyone gets a good rest tonight! :) Good job taking care of Barry! :D
 
Guess who just tested at 6.1?? And, I'm proud to say, I did the test solo and it went quite well, obviously due to a lot of help from Barry himself :cat:
Thank you @MrWorfMen's Mom for the overnight plan! Matt is going to feed Barry shortly and I'm setting an alarm for 5:00 so we can test and feed him again. We will try to get to at least some of your "homework" tomorrow, it will be easier after a better nights sleep!
 
:D Very happy to see that number although I hope he doesn't continue to go up too much higher! I'm really hoping he is in remission.

Congrats on testing on your own. That is a big step forward and if insulin is needed again, it will make keeping Barry safe so much easier. Now I better go grab my little girl's before bed reading and hit the sack like I planned to do 45 minutes ago. Got a little side tracked!:woot: I'm sure everyone at your house will be sleeping much better tonight! ;)
 
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