Help with Low Numbers

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Sly's Human

Sly's Human

Member Since 2020
Hi Everyone,

First of all, I want to say thank you to all of the helpful and knowledgeable people on this forum - this is my first post but I've been reading the forums ever since I adopted my 15 year old kitty in March. We had issues with low BG when we first adopted Sylvester, so through the forum's resources I've learned how to test his blood sugar, watch for the signs of hypo, and manage his dosing.

The last couple months have been going really well - Sylvester has become a much younger and more playful cat than when we first adopted him. After his numbers were consistently good, we would periodically spot test him. We switched him to raw food and he just kept getting better and better with consistent insulin therapy and careful attention.

However! The last three days have been strange. After consistently dosing him at 1.5 units of Caninsulin a day with good results, suddenly he started to seem very lethargic, lost his usually voracious appetite, and began acting strangely. Sure enough, spot tests at +5 and +6 have shown his BG dipping lower than I'm comfortable with. He's the kind of cat that even around 5 mmol/L he begins to sleep a lot, stand in strange places in the house, his pupils dialate, and we know something's off.

A couple days ago he was acting weird, so we spot tested him and his nadir was 3.2. We panicked, fed him, and tested him every 20 mins until he was back in the safe zone. We decreased his dose for the next day and he was ok. Now today, we still gave him a decreased dose (even though his AMPS was 20) but he began acting weird again. Tested him and his BG was 3.7. We panicked again, fed him, and now he's back in the safe zone.

We have a vet appointment tomorrow. In the meantime, how much should we be cutting back on the insulin? This is a lot to put the poor little guy through.

Thank you in advance!

- Courtney & Sly
 
I wouldn't shoot more than 1.0U right now, maybe even lower. Looks like the 1.5U had a real effect, and now you may be dealing with a phenomenon where, after a symptomatic hypo, a cat is more sensitive to insulin for a while.

Has anything else changed recently? How long ago did you switch to the raw food?
 
Ahh okay that makes sense.

We switched to raw food a couple months ago. The only thing I've really noticed is that he hasn't been as hungry as he normally is. It's probably been a week or so of decreased appetite. He still eats most of his food right away, but usually he licks his plate clean and begs for food during the day. Lately he's just been sort of nibbling 3/4 of it and then losing interest.
 
I hope others with more Caninsulin expertise than I will weigh in on this with some more specific suggestions. In the meantime I have another observation from the spreadsheet: on 4/12, he went down to 58 (3.2) on 1.0U. With Caninsulin, we usually reduce by 0.25U any time they go below 90, so he probably should have gone down to 0.75U then.

When/why did you increase to 1.5U? When you say that his spot tests "were good", what kinds of numbers were you getting? Again, we try to keep a pretty wide safety margin for Caninsulin, ideally trying to keep them above 100 (5.5), so "good" numbers (unfortunately) come with some risk. There are other (gentler) insulins than Caninsulin, like Lantus or ProZinc, where it's possible to safely maintain low numbers.
 
Nan & Amber (GA) said:
I hope others with more Caninsulin expertise than I will weigh in on this with some more specific suggestions. In the meantime I have another observation from the spreadsheet: on 4/12, he went down to 58 (3.2) on 1.0U. With Caninsulin, we usually reduce by 0.25U any time they go below 90, so he probably should have gone down to 0.75U then.

When/why did you increase to 1.5U? When you say that his spot tests "were good", what kinds of numbers were you getting? Again, we try to keep a pretty wide safety margin for Caninsulin, ideally trying to keep them above 100 (5.5), so "good" numbers (unfortunately) come with some risk. There are other (gentler) insulins than Caninsulin, like Lantus or ProZinc, where it's possible to safely maintain low numbers.
Click to expand...

Basically because my vet told me to... even in April he wanted me to be giving Sly 3 units. He had a hypoglycemic episode and then the vet said okay, start giving him 2 units. I was super scared so as you can see I brought him up slowly, up to 1.5 units.

"Good" numbers - above 6 and below 12.
 
Nan & Amber (GA) said:
I hope others with more Caninsulin expertise than I will weigh in on this with some more specific suggestions. In the meantime I have another observation from the spreadsheet: on 4/12, he went down to 58 (3.2) on 1.0U. With Caninsulin, we usually reduce by 0.25U any time they go below 90, so he probably should have gone down to 0.75U then.

When/why did you increase to 1.5U? When you say that his spot tests "were good", what kinds of numbers were you getting? Again, we try to keep a pretty wide safety margin for Caninsulin, ideally trying to keep them above 100 (5.5), so "good" numbers (unfortunately) come with some risk. There are other (gentler) insulins than Caninsulin, like Lantus or ProZinc, where it's possible to safely maintain low numbers.
Click to expand...

Sorry I missed one thing - you observed that April 12 he went down to 3.2 and suggested I should have gone down by 0.25 - I actually went down by 0.5 to be safe, even though his PMPS was 18 mmol/l.
 
Sly's Human said:
Sorry I missed one thing - you observed that April 12 he went down to 3.2 and suggested I should have gone down by 0.25 - I actually went down by 0.5 to be safe, even though his PMPS was 18 mmol/l.
Click to expand...

Right, but then you went back up to 1.0U a couple doses later? I think I would have stayed at a lower dose, either 0.5 or 0.75, for a bit longer. The high numbers you saw afterwards were likely due to something we call "bouncing"--- the cat's body reacts to low numbers by panicking a little, dumping sugar into the blood to bring BG back up. This reaction can last for quite a while, a couple days.

Sly's Human said:
"Good" numbers - above 6 and below 12.
Click to expand...

Those are good numbers indeed :)!!!

Sly's Human said:
Basically because my vet told me to... even in April he wanted me to be giving Sly 3 units. He had a hypoglycemic episode and then the vet said okay, start giving him 2 units. I was super scared so as you can see I brought him up slowly, up to 1.5 units.
Click to expand...

:eek: :eek: :eek:

So glad you trusted your instincts-- Sly definitely doesn't need that much insulin!!!!
 
Nan & Amber (GA) said:
Right, but then you went back up to 1.0U a couple doses later? I think I would have stayed at a lower dose, either 0.5 or 0.75, for a bit longer. The high numbers you saw afterwards were likely due to something we call "bouncing"--- the cat's body reacts to low numbers by panicking a little, dumping sugar into the blood to bring BG back up. This reaction can last for quite a while, a couple days.



Those are good numbers indeed :)!!!



:eek: :eek: :eek:

So glad you trusted your instincts-- Sly definitely doesn't need that much insulin!!!!
Click to expand...

Right! Before he came to me the vet had Sly's foster mom giving him 5 units, it was crazy! After spending so much time on this site it's clear people like yourself know much more about managing diabetes than most vets.

Ahhh I see what you mean @Nan & Amber (GA) about holding that lower dose for longer! I didn't know I should be bringing him up more gradually! Very good to know, thank you.
 
ANYTIME, you get a BG < 90 with Vetsulin/Caninsulin, you reduce. And keep the reduction UNTIL the mid-cycle tests tell you otherwise, that the lower dose is not working, but you need to give it at least 6 cycles or more to see if your cat is bouncing.

Right now, I don't think that Sly should be on more than 0.5U.
Do you test for ketones? That is important to do, when your cat has a decreased appetite, since they can form quickly when that happens.

Vetsulin/Caninsulin usually does not have a duration longer than 8-10 hours in most cats. You don't have much test data, but even back in April it looks like Sly's nadir was more around the +4 to +5 timeframe.

You have more data, but haven't updated the SS you say? Please take a few minutes and put in the last 2 weeks of test data, if you would please.

That decreased appetite says that something else is going on with Sly. What else have you noticed going on with him? What else can you tell us?
 
Deb & Wink said:
ANYTIME, you get a BG < 90 with Vetsulin/Caninsulin, you reduce. And keep the reduction UNTIL the mid-cycle tests tell you otherwise, that the lower dose is not working, but you need to give it at least 6 cycles or more to see if your cat is bouncing.

Right now, I don't think that Sly should be on more than 0.5U.
Do you test for ketones? That is important to do, when your cat has a decreased appetite, since they can form quickly when that happens.

Vetsulin/Caninsulin usually does not have a duration longer than 8-10 hours in most cats. You don't have much test data, but even back in April it looks like Sly's nadir was more around the +4 to +5 timeframe.

You have more data, but haven't updated the SS you say? Please take a few minutes and put in the last 2 weeks of test data, if you would please.

That decreased appetite says that something else is going on with Sly. What else have you noticed going on with him? What else can you tell us?
Click to expand...

- Okay, thank you! I'll reduce to 0.5 until the mid-cycle tests tell me otherwise.
- I haven't tested for ketones - I have tried but he's so fluffy/freaks out when I interrupt him while he's peeing that I've never been successful with it.
- That's a good point re: testing earlier, I know that CanInsulin can drop their BG quickly. I usually spot test at +6 because it's the at the insulin's halflife (and what my vet
instructed me to do) but I will start testing earlier.
- I have not recorded the data. For approx. two months I would spot test him around +6 and not record the numbers (the numbers were within the goal range).
- I don't really know what else to say - he's been less hungry, perhaps less vocal and less playful the last week and I noticed that he hadn't been pooping regularly. I talked with my vet, we agreed to put him back on PEG (he had had issues with constipation in the past) to see if he was simply feeling unwell from being constipated. He went back on PEG about 6 days ago. He still eats all of his food, just over a longer time, and drinks water. His skin bounces back when stretched. No diarrea or vomiting. He still jumps up on the bed and the couch.
 
There are blood ketone meters, that test for ketones, for cats that are shy around the litter box.
Try some pee pads in the bottom of the box instead of litter.
Or crumple up some plastic wrap and put that in his favorite pee spot in the box.

Sly's Human said:
I usually spot test at +6 because it's the at the insulin's halflife (and what my vet
instructed me to do) but I will start testing earlier.
Click to expand...
Sorry to tell you this, but +6 is NOT the half-life of Caninsulin. What the +6 represents is the exact half way point of a 12 hour dosing cycle. Not the same at all.

p.s. Oh my, Sly is Wink but with white cheek patches!!! And all his toesies, since an uncaring former owner didn't chop off his toes, against all shelter adoption agreements and then dump their cat at a kill shelter. Wink is why I'm here still, even though he's not with me anymore.
 
Deb & Wink said:
There are blood ketone meters, that test for ketones, for cats that are shy around the litter box.
Try some pee pads in the bottom of the box instead of litter.
Or crumple up some plastic wrap and put that in his favorite pee spot in the box.


Sorry to tell you this, but +6 is NOT the half-life of Caninsulin. What the +6 represents is the exact half way point of a 12 hour dosing cycle. Not the same at all.

p.s. Oh my, Sly is Wink but with white cheek patches!!! And all his toesies, since an uncaring former owner didn't chop off his toes, against all shelter adoption agreements and then dump their cat at a kill shelter. Wink is why I'm here still, even though he's not with me anymore.
Click to expand...

I apologize, I should have said half-way point :) and I'll try your suggestions for testing for ketones.

Well Sly and I are both very grateful that Wink brought you to this site! I've read many of your posts over the months and I've learned so much. I'm clearly not perfect, but we've come a long way thanks to the knowledge and experience you and others have shared on this forum.
 
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