Low BG last two mornings - high dose kitty

[Karen&Rocket]

(also posted in Main forum, but was recommended to post here too)

Hi again all - and sorry for posting again, but Rocket has me a bit confused and I'd like some of your input.

I don't have a ton of data like a lot of you, but his spreadsheet was very scary and angry looking when we first started testing about a month ago. His insulin dose has been raised by half units since his diagnosis in Feb, and he's now on 4.5U of Prozinc 2x/day. I haven't been able to get many overnight readings, but I've tested him 2 hours before his AM shot for the last three days. Yesterday those numbers were 144, today 156 (PM +10). I work evenings, so his shot times are 11:00/11:00, which means I feed him a half can around 9 am when I get up (in this case at testing time), then do the real test-feed-shoot at 11:00. Which makes it hard to figure out his BG, I know. But I'm wondering what those low numbers in the morning could mean. He had dental work done a week ago (cleaning, gum infection cleared up, but no extractions). Is it possible his dose is too high now? That would be fantastic... anyone have experience with something like this?

Edit: his numbers still reach the 400s in the later part of the day (and yesterday, 461 at shot time two hours after the 144). I'm just trying to figure out if this is normal, or some kind of bounce. It doesn't seem normal!

Adding since last post -- his pre-shot test two hours later this morning was 286, which is still lower than what he usually is at that point. So I only ("only?") gave him 4 instead of 4.5 units this morning, and am keeping a close watch on him today. I hope some of you have some thoughts/advice. I do plan on giving his vet this data when I have another day or two logged.

 

[Karen&Rocket]

478 at +2. But he was a bit stressed since I had to try twice to get his blood. Still so very high. I'll try again at +3.

 

[Karen&Rocket]

462 at +3. Sigh. Think I'll try again in an hour and a half or so.

 

[Harukyo]

Hey Keskat! I'm sorry I'm relatively new so I can't give much dosing advice, but hang in there! I think our experts are at work right now. But I've tagged @Djamila and she's amazing. Great job on the testing, the more data the better. Are you rewarding Rocket (beautiful cat btw) with treats every time you test even if you're not successful at getting the reading? I found that that really helped associate testing time with treat time for my sugar kitty, but it definitely takes time to build that association. Hope we can get to the bottom of what's going on with Rocket!

 

[Karen&Rocket]

Hey Keskat! I'm sorry I'm relatively new so I can't give much dosing advice, but hang in there! I think our experts are at work right now. But I've tagged @Djamila and she's amazing. Great job on the testing, the more data the better. Are you rewarding Rocket (beautiful cat btw) with treats every time you test even if you're not successful at getting the reading? I found that that really helped associate testing time with treat time for my sugar kitty, but it definitely takes time to build that association. Hope we can get to the bottom of what's going on with Rocket!

Thank you so much. I just did a +4.5 and it was even higher. 485. So either he needs even more insulin, or this is some sort of bounce, I guess? I don't really understand the bounce concept just yet. I'm going to send these numbers to his vet right now. Hopefully I'll get some kind of response soon, but I have a feeling they'll just want to increase again. So disheartening -what if we're increasing when he needs less? Oh, and yes I am treating during or after testing - little freeze dried shrimp or chicken.

 

[Harukyo]

How long until his next shot is due?

 

[Harukyo]

How long until his next shot is due?

I apologize, I just realized this is a dumb question as you marked that you just tested a +4.5 LOL sorry about that. Well the good thing is that Rockets levels haven't gotten anywhere close to hypo (lime green) ranges. So I'm not sure if it's a matter of giving too much. Again, I'm not nearly experienced enough for true advice giving. Have you been able to test his ketones levels with urinalysis strips or at the vet? How's his appetite?

 

[Karen&Rocket]

I apologize, I just realized this is a dumb question as you marked that you just tested a +4.5 LOL sorry about that. Well the good thing is that Rockets levels haven't gotten anywhere close to hypo (lime green) ranges. So I'm not sure if it's a matter of giving too much. Again, I'm not nearly experienced enough for true advice giving. Have you been able to test his ketones levels with urinalysis strips or at the vet? How's his appetite?

No worries! I appreciate you taking the time to answer. We haven't tested his ketones, but his breath smells normal, and his appetite is still good. He's finishing some food right now that we put down for him a while ago. He drinks a good amount of water (and has since this all started), but it has decreased a little recently if anything. I mean if you look at him, it's hard to tell anything is wrong. So odd.

 

[Harukyo]

That's good that he's a good eater! My kitty is the same and the water drinking will probably continue to decrease a bit since the diabetes is being treated now. I didn't understand just how much water my cat was drinking until her blood sugar levels decreased and I noticed her drinking less and less.

When you get the chance I'd look over the sticky for ketones http://www.felinediabetes.com/FDMB/threads/are-you-testing-your-cat-for-ketones-if-not-do-it.48383/

 

[Karen&Rocket]

That's good that he's a good eater! My kitty is the same and the water drinking will probably continue to decrease a bit since the diabetes is being treated now. I didn't understand just how much water my cat was drinking until her blood sugar levels decreased and I noticed her drinking less and less.

When you get the chance I'd look over the sticky for ketones http://www.felinediabetes.com/FDMB/threads/are-you-testing-your-cat-for-ketones-if-not-do-it.48383/

Will do. Thank you. And give your beautiful kitty a hug for me!

 

[Djamila]

I'll be honest, I'm not really sure what to recommend here. The recent data is helpful, but the gaps are making me wonder what we're missing, especially as I see the +10s overnight. Those are pretty low, which is making me wonder how low Rocket is going during the PM nadir time. I think since you're getting some more tests now, we might wait and see for another day or two and see what shows up.

 

[Karen&Rocket]

I'll be honest, I'm not really sure what to recommend here. The recent data is helpful, but the gaps are making me wonder what we're missing, especially as I see the +10s overnight. Those are pretty low, which is making me wonder how low Rocket is going during the PM nadir time. I think since you're getting some more tests now, we might wait and see for another day or two and see what shows up.

Thank you so much. I was as surprised to see those numbers as you were. Maybe the dental has had a big effect on him? Anyway I'll set an alarm and try to get some earlier overnight numbers.

 

[Margie and Jackson]

Thank you so much. I just did a +4.5 and it was even higher. 485. So either he needs even more insulin, or this is some sort of bounce, I guess? I don't really understand the bounce concept just yet. I'm going to send these numbers to his vet right now. Hopefully I'll get some kind of response soon, but I have a feeling they'll just want to increase again. So disheartening -what if we're increasing when he needs less? Oh, and yes I am treating during or after testing - little freeze dried shrimp or chicken.

I’m not an expert and I don’t use Prozinc, but protocols I’ve read say you should adjust based on the lowest reading, not the highest. I’m interested in what others have to say about bouncing. I think of it as the body’s reaction to having the blood sugar quite a bit lower than usual. Even though it’s not as low as we might want, the body sees it as threatening. I hope Rocket evens out for you!

 

[Karen&Rocket]

I’m not an expert and I don’t use Prozinc, but protocols I’ve read say you should adjust based on the lowest reading, not the highest. I’m interested in what others have to say about bouncing. I think of it as the body’s reaction to having the blood sugar quite a bit lower than usual. Even though it’s not as low as we might want, the body sees it as threatening. I hope Rocket evens out for you!

Thank you. The idea that he might be bouncing makes my head spin. But I don't want to make any assumptions. He just got his PM shot (tested at 415 beforehand). I'll be setting the alarm to try to get some overnight readings. Hopefully he'll be cooperative.

 

[Yong & Maury GA]

Hi Keskat and Rocket!
Handsome boy you have there . I'm a little confused about the feeding schedule. His test time is 1100/2300 but the initial post said you were feeding him half a can at 0900 and again before test time? Can you clarify his feeding schedule please ? We typically recommend them not eating anything 2 hours prior to AMPS/PMPS as the number can be food influenced. If it's because he's hungry, I would aim to give him a snack by 0800 so he has a full 2 hours before AMPS/PMPS. I see he was diagnosed in Feb but the SS starts in May at 3.0U, what was his initial dose? And what were the increases?

Sorry for so many questions but I'm kind of on the fence with Djamila right now with his SS .

 

[Karen&Rocket]

I'll be honest, I'm not really sure what to recommend here. The recent data is helpful, but the gaps are making me wonder what we're missing, especially as I see the +10s overnight. Those are pretty low, which is making me wonder how low Rocket is going during the PM nadir time. I think since you're getting some more tests now, we might wait and see for another day or two and see what shows up.

Hello again Djamila, I'm replying again because I was able to get a couple overnight readings. His PM +4 was 225, and +6 was 212. I also got one at 8 a.m. (+9) which was 365, not in the blues like the last two days. His AMPS this morning was super high - 563. I'm still concerned whether he's getting the right dose, but I'm also thinking I have to completely revamp our feeding schedule. He currently eats several small meals throughout the day - mostly FF pates and some Tiki Cat. Lately I've been also feeding some Nutro Grain-Free Perfect Portions, which isn't on the list, but I wrote to the company and they sent me carb info - supposedly they all range in 1%-3% carbs. BUT, that's an "as-fed" number, not dry matter - which is something I'm just now learning about. SO. MUCH. INFO. It seems sometimes no matter what I do, it isn't right. Anyway, do these overnight numbers help at all? Any ideas? Thank you.

Edit re: the AMPS - I work evenings, so his shot schedule right now is 11:00/11:00 - I usually feed him a small portion when I get up around 8 or 8:30 -- but nothing in the two hours pre-shot. He used to wake me up every day at 5:00 (pre-diagnosis), so 8:00 was actually progress. I'm thinking this might have to change? I'd love to just feed him at shot times, but I'd have a very unhappy kitty. He's more of a grazer unfortunately. Do you think changing his schedule would make a big difference? I'm afraid he'd lose weight, since he won't eat a bigger portion all at once. Sigh.

 

[Karen&Rocket]

Hi Keskat and Rocket!
Handsome boy you have there . I'm a little confused about the feeding schedule. His test time is 1100/2300 but the initial post said you were feeding him half a can at 0900 and again before test time? Can you clarify his feeding schedule please ? We typically recommend them not eating anything 2 hours prior to AMPS/PMPS as the number can be food influenced. If it's because he's hungry, I would aim to give him a snack by 0800 so he has a full 2 hours before AMPS/PMPS. I see he was diagnosed in Feb but the SS starts in May at 3.0U, what was his initial dose? And what were the increases?

Sorry for so many questions but I'm kind of on the fence with Djamila right now with his SS .

Thank you Yong I've explained a little bit about his feeding schedule in my reply above to Djamila. I have kind of a weird schedule, but his shot times are 11:00/11:00. This morning I gave him half a can at 8:00 instead of 8:30/9:00, but his AMPS was 563 (higher than the last two days). I have to work this out... its causing me a ton of anxiety that seems to be getting worse every day.

Edit: adding dosage info -- he was started on 2u 2x/day back in Feb. He was hospitalized after not eating for two days. I wish I would've been able to try changing his diet first before starting insulin, but he was very sick at the time of diagnosis (plus I didn't know half of what I know now). Increases were at .5, not .25 units.

Edit: had to attach a photo of him enjoying the outdoors yesterday. He's leash-trained. He seems normal-ish; you'd never know he's sick by looking at him. I'm baffled.

 

[Djamila]

I would not recommend feeding just at shot time. most of us let our kitties graze, or give several small meals throuhgout the day. Only feeding twice/day can make them grumpy, not to mention it isn't best for the BG.

Those overnight numbers are really helpful because they have a nice drop and curve to them, which means it likely isn't a bounce cycle. It's a pretty decent indication of the current insulin response at this dose. So well done. I hope you haven't suffered the sleep deprivation too much today! how did Rocket do with the extra tests? If he's still struggling with them, you might try continuing to do the desensitization practice with him in between the real tests (read the last section of my "profile" link in my signature for what that means ).

So it looks like he may just be a higher dose kitty. Cats need as much insulin as they need. So don't worry that he needs more than you see on a lot of spreadsheets. That's just how it goes sometimes. There are lots of cats with way more than 4.5u!

Now that being said, we are still going to be doing some guessing and adjusting here for a bit in case that lovely cycle last night is for some reason not indicative of his response (sometimes they trick us). Since you were at 4u for a couple of days, and have now gone back to 4.5u, I would keep both cycles there through tomorrow, and then on Tuesday (during whichever cycle you can monitor the best), I would increase to 4.75 for both cycles. And we'll just keep doing some little increases every few days as you are able to collect data and we can see how he responds.

I know it's hard on the caregiver when a cat needs a lot of insulin, so hugs to you .

 

[Djamila]

By the way, I love your picture! Sam is leash trained too, and he looooooves going out for little walk-abouts as often as I'll let him. He can't use the harness you have though - he wiggles right out of it in a hot second. So he uses one that's a little more vest-like. I have wondered recently if it's worth trying the lighter one again though now that he's had a couple of years on the leash and is calmer and less inclined to try to wiggle out.

 

[Karen&Rocket]

I would not recommend feeding just at shot time. most of us let our kitties graze, or give several small meals throuhgout the day. Only feeding twice/day can make them grumpy, not to mention it isn't best for the BG.

Yay, Rocket will be happy to hear this.

Those overnight numbers are really helpful because they have a nice drop and curve to them, which means it likely isn't a bounce cycle. It's a pretty decent indication of the current insulin response at this dose. So well done. I hope you haven't suffered the sleep deprivation too much today! how did Rocket do with the extra tests? If he's still struggling with them, you might try continuing to do the desensitization practice with him in between the real tests (read the last section of my "profile" link in my signature for what that means ).

Hehe - we had plans today that got cancelled, so I'm enjoying a lazy Sunday at home. Rocket did fine with the tests actually. Well, for the most part. And your profile link is amazing!!! I'm going to sit down and read the whole thing when I'm done here.

So it looks like he may just be a higher dose kitty. Cats need as much insulin as they need. So don't worry that he needs more than you see on a lot of spreadsheets. That's just how it goes sometimes. There are lots of cats with way more than 4.5u!

Now that being said, we are still going to be doing some guessing and adjusting here for a bit in case that lovely cycle last night is for some reason not indicative of his response (sometimes they trick us). Since you were at 4u for a couple of days, and have now gone back to 4.5u, I would keep both cycles there through tomorrow, and then on Tuesday (during whichever cycle you can monitor the best), I would increase to 4.75 for both cycles. And we'll just keep doing some little increases every few days as you are able to collect data and we can see how he responds.

I know it's hard on the caregiver when a cat needs a lot of insulin, so hugs to you

Regarding his curve - since it is a curve, and not flat, I'm understanding that he is most likely NOT an acro or IAA cat; is this a good assumption? Since he is responding to the insulin (though it may not be the correct dose yet)? Since we've been increasing, of course the worry in the back of my head was that testing for acro might be a consideration. And is getting more of a curve overnight normal? His numbers during the day are stressful to look at. I like your suggestion of increasing his dose slightly in a couple days. Our vet has told us to not change dosages without talking to him... he knows we're home testing, and I've sent him a curve before, so I'll probably do that first thing in the morning.

By the way, I love your picture! Sam is leash trained too, and he looooooves going out for little walk-abouts as often as I'll let him. He can't use the harness you have though - he wiggles right out of it in a hot second. So he uses one that's a little more vest-like. I have wondered recently if it's worth trying the lighter one again though now that he's had a couple of years on the leash and is calmer and less inclined to try to wiggle out.

Nice! We have a vest one for Rocket too, but he seems to like the light one better. We take him out for at least half an hour a day. Though with him it's more of a sit-about than a walk-about.

Thank you so much! This website is such a comfort - I truly appreciate the members like you who take time to help. You're awesome.

 

[Djamila]

I wish Sam would do a sit-about! He gets so excited to be outside that he has to explore everything, and then pee on at least two things . It's super easy to get a ketone test out there though since he lifts his tush as high in the air as he can to spray everything. Thank goodness he only engages in that behavior outside.

Alas, I don't think seeing a curve can rule out IAA or Acro. If you look at the spreadsheets of those kitties, they do sometimes have nice cycles. We can certainly hope it's a good sign though.

Vets don't like that we change doses without them, but we all do. First of all, it's too expensive to trot off to the vet every time a kitty needs a dose change. Second, vets don't know as much about FD as we do since this is all we do, while they have to know a little over everything. And third, if we really did call them/come in every third cycle, they would quickly tell us to leave them alone!

 

[Karen&Rocket]

I wish Sam would do a sit-about! He gets so excited to be outside that he has to explore everything, and then pee on at least two things . It's super easy to get a ketone test out there though since he lifts his tush as high in the air as he can to spray everything. Thank goodness he only engages in that behavior outside.

Alas, I don't think seeing a curve can rule out IAA or Acro. If you look at the spreadsheets of those kitties, they do sometimes have nice cycles. We can certainly hope it's a good sign though.

Vets don't like that we change doses without them, but we all do. First of all, it's too expensive to trot off to the vet every time a kitty needs a dose change. Second, vets don't know as much about FD as we do since this is all we do, while they have to know a little over everything. And third, if we really did call them/come in every third cycle, they would quickly tell us to leave them alone!

Thanks again for your help and info, and a good laugh. Our vet tells us to send curve info, etc. by email, but never answers email until I call and leave a message that I’ve emailed. I’ll post again when I get a few more numbers and if I up his dosage a bit. Have a good Monday!