? 05/20 First hypo scare (+2.5 = 3.9, +2.75 = 3.8, +3 = 4.7, +3.25 = 4.9, +3.50 = 5.8)

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Champoux

Champoux

Member Since 2017
AMPS was at 7.9, but my brother and father fed the cat twice in the hour preceding his AMPS, as they didn't know it was best not to do so.

I assumed that the 7.9 I got was probably influenced by a food spike, so I gave him a skinny 0.1 instead of a full one. It appeared that this dose wasn't low enough.

Champagne, who had been sleeping peacefully in his box, suddenly got up at +2.25. I found that unusual as he usually sleeps deeply until +4, only waking up briefly when I bring him food. He paced for a bit then went for the door. As I began putting on his harness, I noticed he seemed a bit wobbly on his feet. I removed the harness and decided to check on him instead. He walked for a bit and sniffed around the house, but he didn't seem as wobbly, though he was still kind of restless. By +2.5, he had a weird head/neck shiver. I then decided to check his BG early, just in case. I usually only test him at +3, because the insulin always seem to start taking effect around this time. I got a 3.9 mmol/L. Since I use an AT 2 meter, the number at which I should start giving HC food is around 3.8, so I gave him a teaspoon of canned K/D and about 10 pieces of M/D kibble.

So far, here's a recap of what happened:

+2.25 = Getting up suddenly, seeming restless and a bit wobbly
+2.5 = Weird head/neck spasms or shivers. BG = 3.9 mmol/L. Gave a teaspoon of K/D canned and some M/D kibble.
+2.75 = Head still having strange spasms. BG = 3.8. Gave another teaspoon of K/D canned.
+3 = Head spasms stopped. BG = 4.7. Went to sleep.
+3.25 = 4.9
+3.5 = 5.8
+4 = 5.8 (apparently he has reached his maximum peak with the K/D ?)

How often should I keep testing him ? Every 15 or 30 minutes ? Should I continue giving HC food throughout the day or should I give dry medium carb food ? This is my first time dealing with a hypo and now that he seems relatively safe I wonder what should I do next.
 
Wow, scary!!!!

I have some trouble "reading" mmol/L (don't worry-- I'm converting them all by hand and not relying on my eye), but I think he's in safe enough territory that you can go to less frequent testing and no more extra HC food. I'd keep a close eye though-- test once an hour until you're sure he won't drop again-- +4 is still relatively early in the cycle.

It's hard to say if the spasms were due to the hypo numbers, but it's a good bet given the test results. Next time, I'd go straight to some honey/karo when he gets that low, whether or not you see those kinds of symptoms. Cats do vary in their tolerance of low BG, and there's also the meter variance to consider.

Whew! Good job bringing him up!
 
Nan & Amber said:
Wow, scary!!!!

I have some trouble "reading" mmol/L (don't worry-- I'm converting them all by hand and not relying on my eye), but I think he's in safe enough territory that you can go to less frequent testing and no more extra HC food. I'd keep a close eye though-- test once an hour until you're sure he won't drop again-- +4 is still relatively early in the cycle.

It's hard to say if the spasms were due to the hypo numbers, but it's a good bet given the test results. Next time, I'd go straight to some honey/karo when he gets that low, whether or not you see those kinds of symptoms. Cats do vary in their tolerance of low BG, and there's also the meter variance to consider.

Whew! Good job bringing him up!
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It indeed was a bit scary, it all happened pretty fast ! Thanks for the advice ! I'm just gonna do a last test right now (+4.5, so 30 minutes since the last one) and if he isn't actively dropping again, I'll wait 1 hour between each test :)

Update: +4.5 = 6.8, he seems ok :) !
 
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OK, just took a look at the spreadsheet, and my goodness! Champagne really has sprinted down the dosing ladder!!!! It's hard to believe this happened on a <0.1U dose!

The reason I was looking at your spreadsheet was to start thinking ahead to the evening dose. Cats who have had a symptomatic hypo (and I think it's reasonable to assume that's what this was, even though we can't know for sure) are sometimes extra-sensitive to insulin afterwards. Hopefully some of the pros will be around at shot time to help guide any dosing decisions, but unless he shoots to the moon, I'd be leaning towards skipping tonight unless you are prepared to stay up to monitor.
 
Good catch with the numbers today! Crazy on such a tiny dose? Looks like he is on the rise now to safe numbers now. What to do about tonight's dose? The next dose for a decrease would be a drop. But, as Nan said, he could be extra sensitive to any insulin after a symptomatic hypo. Maybe the best thing would be to skip tonight and resume tomorrow with a drop.

Do you know how to draw up the drop?

ETA: I agree with Nan that unless he shoots to the moon tonight, I would skip and if you do shoot the drop, be prepared to monitor him closely.
 
@Nan & Amber Since he dropped at such a small dose, I think skipping it would be the wise thing to do tonight. My mother is usually the one on nightwatch, she and I have been taking turns watching him day and night as he's been reacting very quickly to changes in doses since the beginning. She is way less comfortable with the eventuality of having to deal with a hypo than I was, and I wouldn't feel okay giving him his dose and leaving her to deal with that while I sleep (though she'd probably wake me up). So far we've skipped a fair amount of shots in the morning and he tends to stay in the blue even when off insulin for 24 hours. I also think Champagne doesn't get the "usual" lantus cycles, since his nadir practically never occurs at +6. His lowest points seem to be around +3 and +11/+12, always leaving us to deal with frustratingly low preshots :O
 
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Bobbie And Bubba said:
Good catch with the numbers today! Crazy on such a tiny dose? Looks like he is on the rise now to safe numbers now. What to do about tonight's dose? The next dose for a decrease would be a drop. But, as Nan said, he could be extra sensitive to any insulin after a symptomatic hypo. Maybe the best thing would be to skip tonight and resume tomorrow with a drop.

Do you know how to draw up the drop?

ETA: I agree with Nan that unless he shoots to the moon tonight, I would skip and if you do shoot the drop, be prepared to monitor him closely.
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I do know how to draw a drop, although I already find drawing just 0.1 tricky ! I'm wondering if Champagne might not be closer to a honeymoon than we previously thought. It sure is hard to believe that just two weeks ago he regularly hung up in the reds and blacks ! Also where I live, this is going to be a long weekend and I don't want to waste test strips quicker than I can manage. I just opened a new packet of 50 and won't be able to get more before Tuesday. I did look at possible human meters and strips I could buy while I wait for the AT strips to arrive, but sadly in Canada it seems even human test strip are as pricey as the AT's. The only way to have them at lower prices would be to get them from Amazon, but then most don't ship to Canada or if they do, add outrageous shipping fees :(
 
It does look like he is heading for a honeymoon with his numbers. He has responded to Lantus in a remarkable way. Sometimes just changing diet to a low carb wet diet is enough to have kitties get into better numbers quickly. Some kitties get transient diabetes from being on steroids and once removed and a little help with exogenous insulin can do the trick to kick start the pancreas.

The criteria for starting an OTJ trial is :

Reminder: *earning* reductions and starting OTJ trials

However, this is for a kitty that is using a human meter . Your lowest number would be 68 and I hope some peeps more adept with AT2 will guide you with the number range for the higher range for a pet meter. I am not sure.
 
Looking at the spreadsheet, I don't think Champagne is ready to be off insulin. Remember, with an AT meter, numbers need to be below 68 (just like they need to be below 50 on a human meter) in order to reduce the dose. It may be quibbling, but there's a lot more blue than green on this spreadsheet.

I would also suggest that when numbers are running that low, using honey or Karo will bring numbers up faster than a canned food such as K/D. You can use the K/D plus a couple of drops of syrup or use your low carb food with syrup. Alternatively, the "gravy" that is in some high carb food also works quickly. The solids that are in food take longer to digest than the more liquid elements.

Also, if it's not too much trouble, when you are posting numbers, can you use the US system? The majority of members here are from the US and will recognize if your cat is in low numbers sooner than if you're using the international convention.
 
Want to add something here that may pertain to this situation. I have been considering switching from the AT2 to the Relion Confirm and have been doing some comparisons on tests. Today, Shoes had a dropping day down to a 90 and the comparison on the Relion Confirm was a 48! I really think that the members here should consider not saying that 68 on the AT2 is the equivalent to a 50 on a human meter as I have not found this to be true during my comparison tests. I have been doing this for a few months now so I know my number range is accurate.

Sorry for hijacking this thread but I felt like it is very important information for Champoux right now especially considering her situation today.

Added info: I am doing these comparison test using the same drop of blood also.
 
Nan & Amber said:
Very interesting.... I've been wondering about this for a while.
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I have been doing this since the first of the year at random times and did this last year too and I can go back and see that the range comparisons are the same. About 135 on the AT2 is around 85-90 on the Relion Confirm. It really scares me for people sometimes that are using the human meters and keep getting urged to not skip shots, etc. when their numbers are below 90 on a human meter. They don't realize that even with the high cost of the test strips, that the AT2 is the most accurate meter to use. Their vet or vets are not recommending it because they get paid to, they do it because they want their cats to be safe.
 
Based on the numbers you sited comparing the AT to the Relion I think we are keeping them safe between 50-120 on the human meters. ECID but Max never had a symptomatic hypo and he did hit the 30's and 40's. With human meters reading lower than AT it seems to me their actual BG would be higher and thus quite safe.
 
Well, I'm not thinking accuracy so much as correspondence. We're mostly used to "thinking" in terms of human meters, but I don't think we have a great sense of the implications of AT2 numbers. For example, that 135 you got on the AT2 would, on our spreadsheets, be marked as solidly in the middle of the "blue" range, when it's really more like a human meter green number. I wouldn't have guessed that-- I would have thought maybe up to 110 or 120 would be green equivalent, but your data suggests it might be a lot higher, maybe even 140-150! Sheesh.
 
tiffmaxee said:
Based on the numbers you sited comparing the AT to the Relion I think we are keeping them safe between 50-120 on the human meters. ECID but Max never had a symptomatic hypo and he did hit the 30's and 40's. With human meters reading lower than AT it seems to me their actual BG would be higher and thus quite safe.
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With Shoes having survived a hypo and in a coma, my perspective is different. I think that even 90 on the AT2 is too low.
 
Shoeskitty said:
With Shoes having survived a hypo and in a coma, my perspective is different. I think that even 90 on the AT2 is too low.
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Nan & Amber said:
This is what concerns me, too-- I feel like maybe our subconscious standards aren't calibrated properly for the AT2. Really wish there were an authoritative way to convert between the two types of meters.
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I haven't been posting lately, but feel the need to jump in here. I'm going to be blunt so strap on your seat belts and don't take anything I say personally. I care about the caregivers and kitties who come here looking for help... I care enough to say what I'm about to say.

As most of us know, there is no way to convert numbers between a pet-specific meter and a meter calibrated for humans. The problem isn't the protocol. The problem is caregivers deciding to use a meter which was never meant to be used with either of the two protocols we use on the FDMB.

That said, Roomp/Rand were aware some were using a pet-specific meter when following the guidelines in the TR Protocol as described in this forum's stickys. However, let's be very clear... 68 (AT) does not equal 50 on a meter calibrated for humans. Rather, 68 (AT) was simply chosen by Rand for safety... as a reduction point for those using AT meters. It was intended to create a little bit of a buffer for those using AT meters... to keep kitties safe.

Now it gets even more complicated...
In the USA, meters are allowed a +/- 20% variance. In Canada, and I *think* most other countries, there is a +/- 15% variance allowed. In high numbers, this difference alone is enough to make one crazy.

Add to that, because of the methodologies used to determine BG readings (glucose oxidase, glucose dehydrogenase with pyrroloquinolinequinone, and glucose dehydrogenase with flavin-adenine dinucleotide... to name just a few), some meters calibrated for humans are known to read lower than others... on the same droplet of blood. The point here is... not all human meters will give you the same reading on the same droplet of blood.

We've also seen one caregiver after another compare meters calibrated for cats with those calibrated for humans with inconsistent results and that's not even getting into comparing those caregivers results with one another! The point here is... not all pet-specific meters will give you the same reading on the same droplet of blood. Inconsistencies abound!

And then let's not forget about the individual cat... your cat...
We have seen cats who do not exhibit any hypo systems with readings in the teens (human meter) AND we have seen cats (few, but we've seen them) who have exhibited mild hypo systems in the 60s (human meter)... and everything in-between. Heck, I remember one kitty who would regularly drop to LO from vet stress without showing any hypo symptoms (human meter). ECID... it's not just a saying. It's real. It's why the BG numbers are not as important as trends... along with your observations of YOUR cat.

I guess what I'm trying to show by example is there are enough variables at play when one is using the correct equipment (a human meter) for the methods used on the FDMB. Trying to use a pet-specific meter when we're talking safety doesn't make any sense and introduces an unnecessary variable which could easily become a safety issue.

There's no two ways about it. Those choosing to use pet-specific meters while following the protocols used on the FDMB... protocols designed for use with meters calibrated for humans are adding an increased element of risk. Pet-specific meters and those calibrated for human use are not interchangeable when it comes to SLGS and the TR Protocol used on the FDMB.

Just my 2 cents... offered with the best intentions. :)
 
Shoeskitty said:
With Shoes having survived a hypo and in a coma, my perspective is different. I think that even 90 on the AT2 is too low.
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Champagne obviously had a hypo event today at what looked like splitting hairs with what we think is the range for a reduction on the AT 2. Another thing that has to be considered is that the AT 2 also has a +/- variance and what was measuring at 68.4 could have in fact been some where around 56.

I just took pause to read Jill's post above and because of all the variables with meter difference between pet meters and even between human meter against human meter, IMHO, I would go by the symptoms that Champagne exhibited today and would reduce.
 
What I am about to say may be way off in comparing corrective actions of severe aortic valve stenosis of a human to hypos of diabetic kitties. But waiting for the critical number to take place when symptoms are already showing when the numbers suggest only a severe level could be a fatal mistake. as sometimes the first symptom seen of corrective action needed is death. Waiting for that symptom is always too late.

Basically I am suggesting that the symptoms should give precedence to the numbers if the numbers are close.
 
babyBoo said:
Basically I am suggesting that the symptoms should give precedence to the numbers if the numbers are close.
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Always... and the numbers don't even have to be close. Example: the cat I referred to above who exhibited hypo symptoms after dropping into the 60s (human meter).

Always treat for hypoglycemia if any symptoms are seen.
 
Yeah, but 60 is close. I'm more referring to symptoms when the numbers are 185, being similar to symptoms with mild aortic stenosis numbers, In those cases the symptoms are most likely because of a different health reason, that may need some type of corrective action but not the corrective action you'd take with hypos or severe stenosis. I myself experienced symptoms with numbers of almost-severe stenosis and follow-up testing revealed it was definitely not happening from the stenosis. A few years later the corrective surgery was needed, just not then.

Basically I am saying hypo symptoms when several tests show numbers like 85 should be considered hypos whereas the same symptoms at 185 should probably be considered to be from some other reason with a different solution needed.
 
Champoux said:
I did look at possible human meters and strips I could buy while I wait for the AT strips to arrive, but sadly in Canada it seems even human test strip are as pricey as the AT's. The only way to have them at lower prices would be to get them from Amazon,
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Try Ebay - it's a much cheaper source of test strips in Canada when you can't cross border shop like I did.
 
Bobbie And Bubba said:
Hey Champoux, just looked at your SS and see that today was skip too. Nice! I want to share another AT2 users whose cat went OTJ and you might find her SS helpful for when she started the OTJ trial. @Capoo
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Yes ! His AMPS was close to the edge of green and even with a dose reduction, I found that number a bit risky for today. Thank you for the suggestion, I'll check out her SS :) !
 
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