Glucose Curve- Low BG

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Ozzy Pawzbourne

Ozzy Pawzbourne

Member Since 2016
I am doing a BG curve today on Ozzy so I can report back the results to our vet.

Ozzy was prescribed 2 units if vestulin. The first week we were not able to give him his full dose because he was not eating well so we only had been giving him 1- 1.25 u of vestulin.

Today he ate the most food he has for breakfast so we moved his dose up to 1.5. I thought I gave him a fur shot but his numbers have been going down so obviously not.

here are the early results if his curve:
preshot- 324
+2 hrs - 125
+4 hrs - 66!

His numbers are dropping fast and low. I'm shocked! Is 66 too low? Is the vestulin done with it's peak at 4 hours or could he go even lower? Obviously I am concerned! I quicky put out some food for him after the 66 reading. Test again in an hour to see.
 
He is eating now. Good. How much vestulin should we give him for his PM shot? I am think to go back to the 1 or 1.25 u dose. What do you guys think?
 
How soon? Like in 30 mins? How can these curves be accurate if I have to keep feeding him in between? Obviously I can't do that when I am at work! This is crazy stuff! Is 66 too low? Will his numbers drop again on this cycle?
 
Please can you tell me right now which meter type you're using so I can understand whether Ozzy is at a dangerous number.
 
fyi.. i found him laying under the bed before doing his reading. Jsyk- he seems to be acting normal. Doesn't look wierd and isn't acting wierd. he is grooming himself now after his snack. i am watching him closely.
 
Thanks.

On a human meter 66 is still in the normal BG range but it is on the low side and there is still some time to go where the Vetsulin is still at peak effect so you will need to monitor Ozzy very closely for the next few hours (and possibly intervene with carbohydrates).

Don't feed Ozzy too big a meal right now. You may need him to eat again during the cycle and you don't want him to get too full


TEST AGAIN IN 15 MINUTES AND THEN POST THE RESULT HERE. Please include the time after the dose when the test was done in + notation.

(Ozzy could potentially go lower - we need to keep track of BG level, how far along it is in the cycle, and also what/how much is fed.)

We will stay with you through this.

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Keep a close eye on his clinical signs. Make sure you have your hypo supplies near to hand just in case you might need to intervene with extra carbs.

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Ladies- this shiz is CRAZY stressful. While is BG is dropping- my BP is thru the roof! How do you guys do this!!? I was worried when his +2 hr reading was already at 152. My first reactionwas oh good- normal range, then I remembered the insulin hadn't even peaked yet. :eek:
 
Ozzy Pawzbourne said:
I was worried when his +2 hr reading was already at 152. My first reactionwas oh good- normal range, then I remembered the insulin hadn't even peaked yet.
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Correct. That's why I recommended you get the +4 test. Vetsulin only really gets going after +2 so I was worried Ozzy might go a good bit lower.

You are doing a great job with the testing, Joanna. :bighug:

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Ok- he is back up- now at 101. GOOD! Think I am getting a better handle at the pokes. Last 2 times got it on the first try. Guess the trick is to go in the vein at an angle instead of straight down. Will check him again in 30 mins and see how he is doing.
 
That's better. Ozzy's not in any immediate danger.

How long after injection time did you get the 101 reading (+?? format).

Also can you give us an idea of the carb %s for the wet and dry food you gave after the +4 test - and also roughly how much of each Ozzy ate at that time. (It's still early in the cycle so we need to keep track of how many carbs Ozzy is eating in order to assess how he's doing safety-wise.)

Important:

Did Ozzy display any signs of being a bit 'out of it' when you found him under the bed before you did the +4 test (e.g. showing signs of lethargy; not as quick to respond to you as normal; delay in showing alertness after being roused)? This is very important to know.

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Re testing technique, it is definitely better to do the poke at a slight angle.

I need to pop away briefly but I'll be back to check for the next test result.

NOTE: If you get a test at 50 or lower on the Relion rub some karo or honey on Ozzy's gums straight away then test again in 15 minutes.

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+4 hr test was 125. +6 hr test was 66. Freaked out- posted panic posts to this thread back and forth to your responses and gave Ozzy more food. Did another retest at 15 mins after you told me which was actually 30 mins after the 66 reading.

When I went to get him for the 4 hr test, he was sleeping under the bed. When I looked under there, he didn't move but he seemed to be asleep. I literally grabbed him and pulled him out and he whined a little but once he was out seemed normal and mostly annoyed that I woke him from his snuggly slumber. He was acting normal after and seemed to eat fine. Actually, he has been acting normal the whole time. Now he is snoozing up on top of the bed messing up my clean laundry.

Regarding food: I gave him some of the high calorie AD recovery food we brought back from the vet. He doesnt really like it though and onmy took a few bites. Then I pulled out one of his favories I knew he woukd eat Purina Beyond grain fee turkey spinach and sweet potato. He ate a about .3-.5 oz. I tossed in some dry food for extra carbs- the purina cat chow naturals and he took a few bites but I pulled his dish away at this point because you advised not to feed him too much in case I needed him to eat more later.

ok- not best food options, I know. Just wanted him to eat and fast. These are left over foods in our pantry since before the DKA episode. He had been eating the AD recovery, FF classics chicken, and tuna for the last week. I don't know the carb counts on these foods.
 
ok just did another test. His BG is now 140. This is now +5 hr after his AM shot. I am relaxing a bit now. Will test him again at +6 to stay on track with the 12 hr curve test.

Got him again on first poke. Kinda feeling like a rock star now! Hah!:joyful:
 
Ozzy Pawzbourne said:
When I went to get him for the 4 hr test, he was sleeping under the bed. When I looked under there, he didn't move but he seemed to be asleep. I literally grabbed him and pulled him out
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You did exactly the right thing.

Based on the lurk under the bed and the grogginess I think Ozzy may have had a mild hypo. It is good that he became more alert quickly after you got him out from under the bed and that he has acted normally since but continue to monitor his clinical signs closely as well as his BG levels. Note: a cat may become more sensitive to insulin after a low like this.

140 at +5 is encouraging. Continue to monitor clinical signs but don't feed for the time being UNLESS he shows signs of being really hungry. If he does get hungry get a BG test and then give him a small amount of high carb wet food UNLESS he's at 50 or below in which case you should rub honey or karo on his gums to get him back into higher numbers - test again after 15 minutes in this circumstance and give more karo/honey if numbers are still below 50. If numbers are between 50 and 100 at this stage give a couple of teaspoons of wet, higher carb food.

Keep a note of all the test times, BG numbers and what you feed. Having a record of this will help you because you'll be able to refer back to what you fed to get his numbers back up should he ever go into low numbers in the future.

Glad the testing is getting easier!

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Critter Mom said:
FYI - I think the 1.50 IU dose is too high. I think it needs to be reduced.
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I agree about this dose. I'd go back to no more than 1.25 u. Would you be willing to set up the spreadsheet we use here. That makes it much easier for us to help. As you get/log data, patterns and trends will emerge that are very useful in deciding on a dose or predicting the effect of a dose.
 
And can you believe his initial dose upon discharge was going to be 3 u. Then they reduced him to 2 units before we left and we have never given him that full dose yet. We did give him 1.5 one time but before we were testing. He has been on 1.25 for last few days. Will see how his sugars are before dinner and give him either 1 or 1.25. Will check him after.

I will definately use the spreadsheet and post when I have a chance. I actually made my own sheet and have been keeping a log for about a week now so will be easy to transfer into your format. May not get to it till tomorrow- on top of dealing with my kitty almost hourly- also been dealing with Hubby who has developed a skin abcess on his inner thigh. So treating two people today has been fun! o_O

We are headed to a Christmas party here in a bit but it is only down the street so I can come back easily to check on my kitty. If his numbers go low again after his dinner shot, I will stay home so I can monitor him.
 
yes- just did it and am back to post result. +6 hrs-270. So he is going back up. Will not know if 66 was his lowest since we gave him food at the time. Also not sure if +4 hours was his peak. Is doing another curve tomorrow too soon? I got him good again on first poke but he tried to run off and shook his head so the blood drop went flying and had to poke him again.

Remember me mentioning that they shaved my kitty's tum tum so they could do an ultrasound? Well- I have found a LOT of joy in blowing raspberries on his smooth hairless tummy! Gotta find some joy in this! Plus- who gets to blow raspberries on a kitty! So fun! Haha!:kiss:
 
NB: the crystalline fraction of Vetsulin starts to kick in from +7 through to about +10. If you are heading out then to be on the safe side I think it would be a good idea for you to leave out some food for Ozzy (lower carb should be OK now after that 270 at +6) and also to pop back to check his BG levels at +8 to make sure his numbers are staying up
in a very safe range.

If Ozzy were mine I wouldn't give a dose as high as 1.25 IU Vetsulin tonight. You got those low BGs today even though it's possible that Ozzy may have had a partial fur shot this morning. Also bear in mind that many cats run lower at night than during the day. The absolute maximum I would consider giving would be 1.0 unit on the condition that I'd plan to monitor BG until safely past nadir.

Whichever dose you decide to give, Joanna, I strongly recommend that you test at PM+2 to see where the cycle is heading and also at PM+3. If numbers are low again keep monitoring and post for help. If numbers do go low again start a new thread asking for help with very low numbers, set the prefix to 911 to attract attention and tell members who reply to also read this thread so that they can get background on what has been happening.

If the preshot BG is 200 or less post a here on Feline Health - edit the thread title to say need help with Vetsulin dosing. You're in a tricky situation with a cat recovering from DKA; it's not a good plan to skip a dose but you may need to give a reduced dose. I'm tagging @Meya14, @Tuxedo Mom, and @MrWorfMen's Mom to ask them to look in on you if they come online.

If you are in an emergency and you don't get an answer on Feline Health, try posting a 911 on the Lantus & Levemir board (lots of activity there).

Remember, if you are ever in any doubt as to Ozzy's safety go for the honey/karo and take him to an ER vet. Better too high for a day than too low for a minute.

Be sure to let your vet know about today's events at the earliest opportunity.


Mogs
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Thanks for the additonal info Mogs. I really have appreciated all your support today. I will continue to test Ozzy through the 12 hr curve and post back his results.

We have been giving him 1.25 U for the last couple days. I was not able to test until after I came back home from work but he seemed to be doing ok. Although I never knew how low his numbers got since i was not able to be home to test him. Do you think giving 1.25U is too much given today's events? I am not oppossed to going back to 1 u. I will be able to test him again every 2 hrs after his PM shot to see where he is at and plan to.

I will be sending his curve results to the vet tomorrow along with a summary of todays events.
 
Just tested my healthy non diabetic kitty Fig who has never strayed from his 8-9 lbs and has been a grazer his whole life. His BG was 59. He was hungry though and went to his food bowl right after for a few nibbles.
 
Ozzy Pawzbourne said:
Do you think giving 1.25U is too much given today's events?
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Hand on heart, if it were my cat I wouldn't give a 1.25 IU dose tonight, and here are my reasons:

1. The 1.5 dose produced a HUGE drop in BG early in the cycle (>250 points).

2. Many - and possibly most - cats tend to run lower at night.

3. It is possible that Ozzy may have had a mild symptomatic hypo (see my earlier post about this) and there is a risk he may now be more sensitive to the effects of insulin.

4. You don't have much data and don't know Ozzy's pattern of response so it is advisable to err on the side of caution.

Other members may have a different view. Are you able to contact your vet out of hours to seek advice on dosing?

If you're able to do BG tests during tonight's PM cycle it would be really valuable to you.

Are you testing Ozzy for urine ketones every day? I cannot stress enough how very, very important this is for a ketone-prone kitty - especially when the kitty is recovering from DKA.


Mogs
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PS:

Another reason:

FDMB is unusually quiet today so I would worry about how much support might be available tonight should you get another run of low numbers.


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I will only give 1 u. You have given me enough reasons to be more cautious. Thank you.

We have not been testing his ketones daily. He has been clear on ketones for almost 2 weeks now and was tested at the vet just this past Monday and was negative . Our vet said it is not likely he will develop them again if he is eating regularly and getting adequate insulin. He also says that he very rarely sees cats come in with a second DKA episode and that most cat owners are unaware their cat had diabetes (me) and that once they have their kitty on insulin that they usually don't get back in that situation. I am not oppossed to getting a test kit and testing myself. I can pick up one at the drug store. I was just following advice of vet - but he also told me to give my cat 2 u. So????o_O
 
Tomorrow get that spreadsheet going. His numbers may bounce and be on the high side the next few times but I would only do 1 u until you have more data as to how he responds.
 
Ozzy Pawzbourne said:
He also says that he very rarely sees cats come in with a second DKA episode
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He probably doesn't see new diabetics as frequently as we do here. Unfortunately we do see a fair number of DKA relapses here (Mayton, for example) hence the suggestions we make about diligence when it comes to monitoring in cats who are known to be ketone-prone. In addition to DKA being a miserable and dangerous thing for a cat, as you have already discovered DKA treatment is hard on the kitty and hard on the pocket.

Often we see DKA cats who are released from hospital too soon or whose caregivers are not given the right meds to support post-DKA kitties during their convalescence (e.g. anti-nausea and appetite stimulant meds). The poor things get home, they struggle to eat, and they slide straight back into DKA.

Ketones can develop very quickly and unexpectedly. The couple of minutes out of a day that it takes to do a test helps to protect a ketone-prone kitty is a very worthwhile investment - especially for kitties who are still recovering from a DKA episode. If ketones are detected early prompt treatment can prevent a cat from going into DKA (better all round - for cat and pocket!).


Mogs
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+8 hrs- 322. Kitty is hungry but its still 2.5 hrs till his dinner time. Do I feed him or make him wait?

Will get the spreadsheet up and ketone strips tomorrow.
 
I agree with the 1U tonight with monitoring a few times to see where the sugar goes. If tonight's nadirs (there are 2 with vetsulin) is >200, then it might be worthwhile to consider going back up to 1.25U tomorrow, and perhaps "feeding the curve" with close monitoring. Sometimes, because an insulin peaks a little too sharply, the preshots can be very high, but nadirs too low. To even out the curve, feed your normal food on the schedule you are on, but 1 hour or so before the nadir, give a small meal of medium carb food. I'm not as experienced with using vetsulin, but I think Critter Mom said about +4 and +10, so feed medium carb at +3 and +8 or 9.

After DKA, goal is to keep most readings between 150- about 220ish. It might take a mix of adjusting insulin and steering sugars with extra food. Aiming for this higher range will prevent the need to skip shots, which isn't a great idea if you can avoid it.

And your vet is correct, most undiagnosed kitties who develop DKA at that time have a much easier and predictable recovery. But man, that $10 for ketone strips can save thousands!
 
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