Second night of lows 38-40 Yikes!

Laurasboyz

Member Since 2020
Hi there,

I'm Laura and my cat Toeby was recently DX'd. The vet started him on a half unit of Lantus twice a day. We stopped feeding any dry food, even the dry Purina DM sent home by the vets. He's been eating canned pate and freeze dried Stella and Chewy's chicken. After 2 weeks without home testing, he had a glucose curve done at the vets. I didn't get to see the curve (long story involving Covid-19 restrictions at the vet) but I was told he started out at 7 mmol/L (126 mg/dL) after his insulin, went UP to 14 or so (250 mg/dL) and fell back to 7. The vet said she thought we might have to move to 1 unit once a day, but to take him home, carry on at 0.5 units b.i.d., and come back in 3 or 4 weeks for another curve. I was assured he wouldn't go hypoglycemic on a half unit. We went and bought a Freestyle Libre monitor and reader with the thought that we'd get the vet to apply it, perhaps next week if we could get in. He is a former feral, and has not like being manhandled.

Wednesday morning of this week something was obviously wrong with him - I found a battery for an old glucometer, and the out-of-date strips and took a reading - 1.9 mmol/L (just over 30 mg/dL). Yikes! I gave him higher carb food and he felt better. I'll never know if those old strips were accurate, but he was telling me he felt awful, so I believe the reading.

I immediately went out Wednesday and bought new strips with the new glucometer - One Touch Ultra 2 and have been doing preshots and spot checks. He's surprised us, and takes the ear sticks like a champ.

This morning his BG was only 7 (126 mg/dL)- I decided not to give him insulin because he wasn't eating much and I felt that was a recipe for disaster. He did eat some wet food over the day today.
Tonight, his preshot BG was 11 (198 mg/dL) - I gave his half unit. 4 hours later he was at 2.1 (37.8 mg/dL) and from what I have read here, that was hypoglycemic.... although he exhibited no symptoms.
I gave him corn syrup and food and after a couple hours he was back up to 7.1 (128 mg/dL).

It seems to me that despite the curve at the vet's, he is responding to the Lantus, and I am at a loss if I should try to give LESS than 0.5 unit twice a day, or switch to once a day, or just see if food alone will keep him low enough? Was I wrong not to give him insulin when he was at 7 (126 mg) ??? This vet has NOT been impressing me with information or support, so I am asking here. Please be assured I will call the vet, but I am asking here in the meantime for opinions. Thanks for reading this!
 
Welcome Toeby and Laura.
Good catches on getting those low numbers. The numbers are often higher at the vets due to stress.

I would reduce the insulin to 0.25 units twice a day and see how he goes on that.
Try and get tests in earlier than +4 and +5 when he had the low numbers. Then you can feed him to stop him dropping too low.
Are you giving smaller meals during both cycles as well as before the shots?
 
Welcome to the group!

I agree with what Chris posted on Health and what Bron posted above. When a cat drops into lower numbers, definitely below 50 (we tend to use US numbers -- mg/dL-- here since most members are from the US and we're metric challenged), you want to reduce the dose. It's a signal that the dose is too high. So, drop the dose to 0.25u twice a day.

I want to double check that you're using a syringe rather than the Lantus pen to dose your insulin. Hopefully, you have syringes that are marked in half unit increments. The half units will make it easier to draw up a 0.25u dose.

You're doing great with getting started. I'd encourage you to look over the sticky notes at the top of the board. They will provide a crash course in using Lantus. There's a huge amount of information in the sticky so expect to feel overwhelmed. I'd also strongly suggest you look at the sticky on handling low numbers. Toeby seems to want to keep you on your toes so it will be useful reading.

The other suggestion I'd offer is to make sure to give Toeby a low carb treat every time you test. Associating testing with treats will help to keep your kitty accepting of those ear pokes.
 
Thanks everyone... he tested at 223 (12.4 mmol/L) this morning so I gave him a shot of 0.25 unit and he was 194 about 1.5 hours later. Yes, I am using BD brand half unit insulin syringes. He is taking the ear sticks surprisingly well. As far as the size and frequency of his meals... he and his brothers have been grazers all their lives (they're 15 this year). They were trapped feral kittens, and hooked on kitty crack dry kibble when I got them from the SPCA. It took a long time to get them to eat canned, and they've never preferred it. In the past year they've been prescribed diets like Hills I/D for GI issues, and the dry I/D seemed to be helping but now this cropped up. Now I have them both back on just the Stella and Chewy's and canned pate. They both do not seem to have a lot of enthusiasm for meals recently. Withholding food to get Toeby to eat twice a day to sync with shots has not worked, so we leave their food down for them to pick at. Hope that answers any questions. I am reading the stickies... but, yes, it's overwhelming. It's nice just to talk about it with other people, for sure. Thanks again. Laura
 
So...I reduced his dose to 0.25 (or as well as I could ballpark that in the half unit syringes we have), and gave him 0.25 this morning after a preshot value of 223 (12.4), and 0.25 tonight based on a preshot of 167 (9.3). I checked his BG's this afternoon three times and they were pretty good, I thought. Then tonight, at 10:45 - he gives me a reading of 40 (2.2).

I have just given him some gravy Fancy Feast, which he has gobbled down - he is showing no symptoms of hypoglycemia. I will check his blood again shortly.

Is it fair to assume he should NOT be on insulin based on these super low readings at night? Or at the least, maybe needs only 1 shot per day?
This is nuts... I cannot see administering less than 0.25 units per shot.... I would be guessing at best.
Am I jumping the gun on assuming this?
I have no intention of giving him insulin in the morning at this rate...
 
I have no intention of giving him insulin in the morning at this rate...

Don't blame you a bit...I really have to wonder if the only reason he was diagnosed as diabetic in the first place was because he was on a high carb kibble and he was stressed out at the vet.

Even your vet said "pre-diabetic".....and if I remember right, you said he had none of the usual signs like drinking huge amounts of water, peeing an ocean or losing weight despite eating lots of food.

I think you might want to just stop the insulin for at least a couple days but continue testing. If the AM test is above 100, go ahead and feed him and test again in about 3 hours. If the AM test is below 100, you could probably just wait to test again at the PM time or you could just test to gather data...totally up to you.

There actually are lower doses than .25 but let's not go there unless we really need to.
 
Don't blame you a bit...I really have to wonder if the only reason he was diagnosed as diabetic in the first place was because he was on a high carb kibble and he was stressed out at the vet. Even your vet said "pre-diabetic".....and if I remember right, you said he had none of the usual signs like drinking huge amounts of water, peeing an ocean or losing weight despite eating lots of food.

Hi Chris, thanks for your comments... I am fighting with myself for being so negative about his diagnosis... I tell myself that I'm in denial because facts are facts, but.... The vet said that she conferred with another vet who saw Toeby in March for a similar vomiting/diarrhea episode. At that time in March he had elevated blood sugar levels, but he always does at the vet.. he is a former feral and a bit nervous out of his element. THIS time, she said, sugar was spilling into the urine, so it was a sure sign of diabetes and not vet-related stress. So I was passed his carrier in the parking lot of the clinic (we were not allowed in side due to Covid-19 restrictions) along with some syringes, a vial of insulin, a bag of DM, and the bill.... "bring him back in 2 weeks for a curve". Which we did. And while his blood sugar there climbed rather than drop, an inverse curve, I was told to keep him on the half unit dose b.i.d. and come back in a month. I told her I had experience home testing, but he HATES being picked up and held so I wasn't sure how I'd do home testing him, and I was worried about hypos. I was assured he could NOT go hypoglycemic on a half unit b.i.d. She told me if I wanted, she'd stick a Freestyle Libre on him. I actually went out last Friday and bought one with the monitor... was going to call and make an appt, but then Wednesday happened and I started home testing regardless. He has been a champ about ear pricks, really good, actually. I think the Freestyle Libre is going back to Costco next week. Sigh... anyway... I just find it hard to think I can keep giving him insulin with numbers like these.... I am hoping diet will control whatever she thinks is going on... but what do I know? Not much. A friend who is a pharmacist said "If you're not diabetic, and you take insulin, you can go hypoglycemic". I tend to agree....
 
And he went to college for how many years to come up with that statement?....Uhhhh...DUHHHH

Haha.. the pharmacist is a woman, and she was being sarcastic. I was worried about not home testing, but was told by another medical professional that there was "NO chance" that 0.5 units would cause him to go too low. And vets go to college longer than pharmacists, but what do I know, I've only got a dumbass B.A. Bahaha. But I know this, I read a 38 on my brand new One Touch glucometer... no, actually that is a lie, I read 2.1, to be precise... mmol/L. :-)
 
Hello and Welcome to the LB&L forum! I see you've already learned that lesson about vets, etc. No need to add that we've heard that tale a thousand times around here.

You've also gotten some very excellent advice from the above posters!! You'll find as you read through the information here (the stickies as mentioned above) that the collective knowledge and experience of this group of folks far exceeds anything 99% of professionals (yes, I'm referring to vets for the most part) understand about FD (Feline Diabetes). It's a sad statement but unfortunately true - because they just simply do not have time to delve into the deep depths of learning about FD and how to treat it. It's almost as if cats are second rate and they don't care enough to learn - but I think it's just a matter of the lack of time ... personally I'm waiting for the day when a professional recognizes that it's a significant problem and there will be specialists for feline diabetes, just like there are for other issues...but it might not happen in my lifetime - so I'll stick with this group and save the life of my girl :)

Have a great day! Looking forward to reading your posts!
 
Good Morning! I don't think I am doing this thread thing correctly - I had changed the title once to try to make sure it got bumped up... but I see now I am now following different threads... If someone could please gently telling me what I am doing wrong so I can follow this, and ensure people can see it for when I am looking for timely guidance that would be great???
I thought the idea was to have one thread per cat, but maybe I am wrong?

Toeby was 158 this morning (8.8) and I have elected to NOT give him insulin.

We are going out today and will not be able to test him for about 6 hours.
Better safe than sorry.

He did have the high carb gravy FF last night to bring him up from the low test of 40, so... the 158 does not surprise me... he was 182 before I went to bed.

Any input would be appreciated.
Laura
 
Hi Laura, and welcome! We like to see one thread per day for your cat. Typical your post title will have date, kitty’s name, and glucose test results. You can add brief questions to the title as well. Use the ? from the drop down list to let folks know there’s a question in your post, then remove it once the question has been answered. Use the 911 from the title drop down when you need urgent help (kitty is hypo, for example) and remove the 911 when the situation is resolved.

Something that really helps for continuity it to paste a link to your last post within your current post. That lets people go back and follow your story without having to search the forum for it. You can look at my post for today to see how it all lays out. I’m Erin and Moe.

Also, I discovered that just changing the title will not bump up your post; you must add a comment to bring it back to the top of the pile.

Hope that helps. It is confusing at the beginning.
 
The medical professional who mentioned that it's not possible for hypoglycemia to occur on a dose of 0.5u was likely thinking in human terms. I've found it helpful to ask if that would be true for an infant (since an infant weighs in the same range as a cat). I suspect you will get an answer of, "Geez....good question." While vets do spend 3 years minimum in training, they get about 2 hours of lecture on diabetes in all types of animals. I can guarantee that many of us have done way more reading than that!!

You may want to revisit the sticky for new members on the basics. The section at the top reviews the conventions for posting that we use here.
 
One thing that would really be helpful is to update the title at the top of 'this' thread to the same format that we typically use: So it would be like this:

(date that you posted, yesterday? today? even I'm not sure, since it looks like it started yesterday, but is running into today...is there a new post today?)

So the format for yesterday would be 7/18 Tobey AMPS# - then your question...

If you have a new thread today, then this thread would be referenced in that thread by copying/pasting the url from the very top into the new thread..

I was so confused at first ... don't feel badly...we all learn the way.....it just takes a little time...and we all understand how overwhelming all of this is. We were all there once ourselves! :bighug:
 
The medical professional who mentioned that it's not possible for hypoglycemia to occur on a dose of 0.5u was likely thinking in human terms. I've found it helpful to ask if that would be true for an infant (since an infant weighs in the same range as a cat). I suspect you will get an answer of, "Geez....good question." While vets do spend 3 years minimum in training, they get about 2 hours of lecture on diabetes in all types of animals. I can guarantee that many of us have done way more reading than that!!

You may want to revisit the sticky for new members on the basics. The section at the top reviews the conventions for posting that we use here.

I was referring to his vet when I said "medical professional". She's the one who said he would not hypo on 0.5 units when I said I was nervous about insulin without doing home testing. I really didn't think I would be able to home test - he has proven me wrong so far, being remarkably compliant. Thankfully! I haven't posted on one of these boards in a long time, and I realize I really must be more clear when I write - perhaps less wordy. You get used to writing to friends who know you and posting for people who aren't familiar with you is different, I think. I will re-read the sticky and try to be better. :-)
 
Hi Chris, thanks for your comments... I am fighting with myself for being so negative about his diagnosis... I tell myself that I'm in denial because facts are facts, but.... The vet said that she conferred with another vet who saw Toeby in March for a similar vomiting/diarrhea episode. At that time in March he had elevated blood sugar levels, but he always does at the vet.. he is a former feral and a bit nervous out of his element. THIS time, she said, sugar was spilling into the urine, so it was a sure sign of diabetes and not vet-related stress. So I was passed his carrier in the parking lot of the clinic (we were not allowed in side due to Covid-19 restrictions) along with some syringes, a vial of insulin, a bag of DM, and the bill.... "bring him back in 2 weeks for a curve". Which we did. And while his blood sugar there climbed rather than drop, an inverse curve, I was told to keep him on the half unit dose b.i.d. and come back in a month. I told her I had experience home testing, but he HATES being picked up and held so I wasn't sure how I'd do home testing him, and I was worried about hypos. I was assured he could NOT go hypoglycemic on a half unit b.i.d. She told me if I wanted, she'd stick a Freestyle Libre on him. I actually went out last Friday and bought one with the monitor... was going to call and make an appt, but then Wednesday happened and I started home testing regardless. He has been a champ about ear pricks, really good, actually. I think the Freestyle Libre is going back to Costco next week. Sigh... anyway... I just find it hard to think I can keep giving him insulin with numbers like these.... I am hoping diet will control whatever she thinks is going on... but what do I know? Not much. A friend who is a pharmacist said "If you're not diabetic, and you take insulin, you can go hypoglycemic". I tend to agree....
You can order the Libre from Abbott in Canada and you receive it within 2-3 days normally. I found it at shoppers as well.
 
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