? Time for a Dose Reduction?

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Oscar and Carrie

Oscar and Carrie

Member Since 2021
Hi,

I'm sorry to repost from the ProZinc forum but I need some advice.

Oscar's BG is has dropped from 6.4 @ +2 to 3.0 @ 3.3

I will test again in 10 mins, but would you recommend I give him some high carb food with gravy right now regardless? I will also be dropping his dosage from now.
 
If Oscar's numbers are still in the bright green, please add 911 to your thread title.

I'm not experienced enough to give advice, but if it were my cat I would at least be giving MC.

excerpt from How to treat HYPOS - THEY CAN KILL! Print this Out!!

LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a low number (40 – 60mg/dL or 2.2 – 3.3mmol/L) give food or treats until the blood glucose numbers rise to an acceptable level. If the cat refuses to eat even his/her favorite foods, you can syringe feed or administer a small amount of syrup.

LOW NUMBERS – MILD SYMPTOMS
Try feeding first or give a little syrup or honey followed by food until the blood glucose numbers rise to an acceptable level and the symptoms disappear. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If the cat will not eat, syringe feed. If your cat will eat dry food. the high carbs will help to increase his/her bgs quickly, but remember the effects of dry food usually takes longer to clear kitty's system once the crisis has passed. Feeding a high carb canned food is preferable to feeding a high carb dry food because the effects will clear kitty's system faster. You can then follow with his/her favorite canned food. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

LOW NUMBERS – MODERATE SYMPTOMS
Give a tablespoon of syrup, a teaspoon of liquid glucose, a tablespoon of honey or a tablespoon of sugar syrup followed by food and continue doing so until you see the blood glucose numbers rise to an acceptable level and all symptoms disappear. The syrup, honey, or glucose can be rubbed against the inside of the cat’s cheeks or on the gums for quick absorption. You can also mix the syrup with wet food or pour over dry if the cat will eat it. Continue to give syrup and food as needed and observe your cat for signs of recurring hypoglycemia. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.
 
Nan & Amber (GA) said:
Yes, please give a couple teaspoons of the gravy from the gravy food (you don't want to fill him up with the food) or a few drops of honey/Karo.

Test again in 30 minutes. Good catch!
Click to expand...

Thank you, someone responded to me on the FB group, and I gave him a tablespoon of MC wet food about 20 minutes ago. I've just retested and it was up to 4.0.

I'll test again in about half an hour to check that it doesn't start to go back down again.

I've also managed to get a last minute vet appointment this evening to discuss his dosage. I'm hoping they agree he is definitely on too high a dose right now.
 
Great!

Yes, keep testing on the 30min schedule for a while. Especially with it being so early in the cycle, he may not be done dropping yet.

What we usually recommend is:

--high carb snack when he drops under 3.7 (on an AlphaTrak).
--If he rises over that (as he just did), try not giving HC on that round, but keep testing on the 30min schedule.
--If he manages to keep over 3.7 without food for a few such tests, you can relax, but any time he drops under, more HC and the clock re-starts

Yes also to reducing the dose! We usually go in 0.25U increments, so down to 1.0, but your vet may recommend a bigger decrease. Looking at Oscar's spreadsheet, he looks like he might be in a hurry to race down the dosing scale :). It looks like the food change you just completed is really having an effect, I'd definitely mention it to the vet when you discuss dosage.

So glad you are testing!
 
Hi Carrie,

Good job catching that 3.0 reading.

Oscar and Carrie said:
I'll test again in about half an hour to check that it doesn't start to go back down again.
Click to expand...
As noted in earlier replies to this thread, it's still fairly early in the cycle. Looking at Oscar's spreadsheet, a few days ago he dropped a lot between +4 and +6, and he didn't rise all that much by the time the next preshot test was due. I'd suggest using that as a guide for your testing today. In particular, I'd suggest testing every 30 minutes till at least +6 in case numbers might drop down again. After that point, I'd suggest letting the trend in numbers and whatever foods you've used to steer numbers guide your testing frequency. You can always post for further help if you need it.


Mogs
.
 
Nan & Amber (GA) said:
Great!

Yes, keep testing on the 30min schedule for a while. Especially with it being so early in the cycle, he may not be done dropping yet.

What we usually recommend is:

--high carb snack when he drops under 3.7 (on an AlphaTrak).
--If he rises over that (as he just did), try not giving HC on that round, but keep testing on the 30min schedule.
--If he manages to keep over 3.7 without food for a few such tests, you can relax, but any time he drops under, more HC and the clock re-starts

Yes also to reducing the dose! We usually go in 0.25U increments, so down to 1.0, but your vet may recommend a bigger decrease. Looking at Oscar's spreadsheet, he looks like he might be in a hurry to race down the dosing scale :). It looks like the food change you just completed is really having an effect, I'd definitely mention it to the vet when you discuss dosage.

So glad you are testing!
Click to expand...

Just retested and it had dropped again to 3.1, so I've given him another tablespoon of MC food with a teeny drop of honey in it. Will recheck again in 30 mins.
 
SashaV said:
Did you check the carb content of the Royal Canin you're feeding?
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Yes I did, though I'm not sure which number is the correct number:

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Do you have a new reading?

You need to test during his PM cycle too.
That pink day might have been from a low during the night before.
 
SashaV said:
Do you have a new reading?

You need to test during his PM cycle too.
That pink day might have been from a low during the night before.
Click to expand...

Yes, just done one at +5.5, BG was 3.7

Will test again in 30 mins to check it is still going up.

I will try to start getting some PM readings as well
 
SashaV said:
The dry matter. So you're feeding 32% carbs.
Click to expand...

Ah okay! I've just done a comparison and his normal Sheba food works out at 3%. I take it then I might see a higher than normal number later on since he's now had a couple of tablespoons of the RC? Don't worry, I will still make sure to reduce the dose.
 
Oscar and Carrie said:
Yes, just done one at +5.5, BG was 3.7

Will test again in 30 mins to check it is still going up.

I will try to start getting some PM readings as well
Click to expand...
Many do a before bed test, at around +2. It might tell you if it's going to be an active cycle. I found that my Mauer on prozinc dropped around +6, so I did +5 so I could catch her in time.

Did you feed him again? Honey wears off fast. And the food you're using is HC. Not necessarily higher numbers later, since you have a hard time keeping him up as of now.

Good you're already reducing! You might want some inputs to what dose you'll shoot tonight, based on his low numbers today. They get more sensitive after a low BG.
 
SashaV said:
Many do a before bed test, at around +2. It might tell you if it's going to be an active cycle. I found that my Mauer on prozinc dropped around +6, so I did +5 so I could catch her in time.

Did you feed him again? Honey wears off fast. And the food you're using is HC. Not necessarily higher numbers later, since you have a hard time keeping him up as of now.

Good you're already reducing! You might want some inputs to what dose you'll shoot tonight, based on his low numbers today. They get more sensitive after a low BG.
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No I didn't feed him after the BG 3.7 reading.

I will definitely post for advice, I normally take his PMPS reading at about 6:30PM UK time, so hopefully people are around to advise.

I also have a vet appointment at 5:30 this evening so will see what they suggest as well.
 
Oscar and Carrie said:
No I didn't feed him after the BG 3.7 reading.

I will definitely post for advice, I normally take his PMPS reading at about 6:30PM UK time, so hopefully people are around to advise.

I also have a vet appointment at 5:30 this evening so will see what they suggest as well.
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Then go ahead and feed more.
Any neongreen is bad, specially since you're new at this.

Just so you know, in case you don't, 3.7 is a great number, the reason you need to react to it, is because you're using a meter for felines. If you were using a human meter, 2.8 would be neongreen. When all this is over, you might want to think about switching meters. The AT2 is very expensive.

I'll tag @JanetNJ and @Deb & Wink for you, they can advise you on dosage for tonight.
 
SashaV said:
Then go ahead and feed more.
Any neongreen is bad, specially since you're new at this.

Just so you know, in case you don't, 3.7 is a great number, the reason you need to react to it, is because you're using a meter for felines. If you were using a human meter, 2.8 would be neongreen. When all this is over, you might want to think about switching meters. The AT2 is very expensive.

I'll tag @JanetNJ and @Deb & Wink for you, they can advise you on dosage for tonight.
Click to expand...

Haha I am well aware of how expensive the AlphaTrak is :( Already used £8 of strips just today. I have ordered another 50 but will definitely look at switching to a cheaper one once I get through these.

Will feed him a little bit more now, would you still recommend me re-testing in about 10 mins?
 
Oscar and Carrie said:
Haha I am well aware of how expensive the AlphaTrak is :( Already used £8 of strips just today. I have ordered another 50 but will definitely look at switching to a cheaper one once I get through these.

Will feed him a little bit more now, would you still recommend me re-testing in about 10 mins?
Click to expand...
Keep testing until he is in safe numbers, have have stayed there for 2 hours in a row, without food. So the clock starts over every time you feed him. Test every 20-30 minutes.

50 won't last long, so don't worry. How many do you have left?
I believe the gluco navii is your cheapest meter and strips.
I used about 80 this past week :nailbiting:
 
SashaV said:
Keep testing until he is in safe numbers, have have stayed there for 2 hours in a row, without food. So the clock starts over every time you feed him. Test every 20-30 minutes.

50 won't last long, so don't worry. How many do you have left?
I believe the gluco navii is your cheapest meter and strips.
I used about 80 this past week :nailbiting:
Click to expand...

Okay, he's just finished eating so I will recheck in 30 mins.

I have about 30ish left in the tub, and then have ordered another 50 to arrive mid next week.
 
You want to monitor for at least 2 hours after lows like that. More, if you've "carbed up" your cat to get him above 68mg/dL (3.7mmol/L) on an AlphaTrak. So 2 hours without food after your cat has dropped really low. You want the BG level to be at LEAST 90 AND rising before you stop testing. Depends on where in the 12 hour cycle you are too.
 
Nan & Amber (GA) said:
:)

I think you still have to test again in 30, but we may have to adjust the strategy a bit to account for the number of strips you have. You'll be fine for today, it's just a matter of making sure you have enough to last until, what, Wednesday you think?
Click to expand...

I can always nip to the pharmacy and buy a human meter early if I am running out before they arrive! And yep, I'll keep testing for the next few hours to see how it is going.
 
Shelley & Jess said:
You want to monitor for at least 2 hours after lows like that. More, if you've "carbed up" your cat to get him above 68mg/dL (3.7mmol/L) on an AlphaTrak. So 2 hours without food after your cat has dropped really low. You want the BG level to be at LEAST 90 AND rising before you stop testing. Depends on where in the 12 hour cycle you are too.
Click to expand...

I will keep testing, don't worry :)

The last test I did was at +6, which is typically his lowest from what I've seen so far.
 
Let's talk about food...
02/16 - Started wet food
02/25 - Switched to all wet food

What were you feeding before you started wet food?

02/25 - Are you feeding all LC wet now? No MC or HC at all?

I'd drop that dose to 0.5u and hold it for at least 6 cycles unless he tells us he need another reduction sooner. Do not be tempted to give more insulin if you have a high pre-shot.

The food change looks to be having a huge impact on the BG. This morning AMPS he was in normal numbers when the insulin was basically wore off. No food bump this morning at +2 either.

He may need his dose increased later but for now I recommend dropping that dose to 0.5u and see what it does for Oscar.
 
Shelley & Jess said:
Let's talk about food...
02/16 - Started wet food
02/25 - Switched to all wet food

What were you feeding before you started wet food?

02/25 - Are you feeding all LC wet now? No MC or HC at all?

I'd drop that dose to 0.5u and hold it for at least 6 cycles unless he tells us he need another reduction sooner. Do not be tempted to give more insulin if you have a high pre-shot.

The food change looks to be having a huge impact on the BG. This morning AMPS he was in normal numbers when the insulin was basically wore off. No food bump this morning at +2 either.

He may need his dose increased later but for now I recommend dropping that dose to 0.5u and see what it does for Oscar.
Click to expand...

Before the wet food he was on Royal Canin Diabetic Dry food (as recommended by the vets), started to transition to Sheba Fine Flakes as soon as I started to do research and found this forum. He's now 100% on that food, with freeze dried chicken and cod as little treats after his BG tests. No MC/HC at all.

Don't worry, I will not be giving him a higher dose! I'll suggest dropping to a dose of 0.5 to the vet later and see what their reaction is.
 
SashaV said:
The dry matter. So you're feeding 32% carbs.
Click to expand...
FYI, Sasha, kilocalories from carbs (value used in Dr. Lisa's tables) in this food are 37.7%. (There's usually a bit of difference between the ME% and the DM%, sometimes it's higher, sometimes lower.)

upload_2021-2-28_14-38-38.png


@Oscar and Carrie -

Carrie, here's a link to the handy calculator I used for the above:

https://secure.balanceit.com/tools/_gaconverter/index.php

(Sorry to be dropping it on your thread while you're managing numbers but I have memory problems and I won't be able to remember to do it later.)


Mogs
.
 

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Critter Mom said:
FYI, Sasha, kilocalories from carbs (value used in Dr. Lisa's tables) in this food are 37.7%. (There's usually a bit of difference between the ME% and the DM%, sometimes it's higher, sometimes lower.)

View attachment 59987

@Oscar and Carrie -

Carrie, here's a link to the handy calculator I used for the above:

https://secure.balanceit.com/tools/_gaconverter/index.php

(Sorry to be dropping it on your thread while you're managing numbers but I have memory problems and I won't be able to remember to do it later.)


Mogs
.
Click to expand...

Thank you, bookmarked!
 
Critter Mom said:
FYI, Sasha, kilocalories from carbs (value used in Dr. Lisa's tables) in this food are 37.7%. (There's usually a bit of difference between the ME% and the DM%, sometimes it's higher, sometimes lower.)

View attachment 59987

@Oscar and Carrie -

Carrie, here's a link to the handy calculator I used for the above:

https://secure.balanceit.com/tools/_gaconverter/index.php

(Sorry to be dropping it on your thread while you're managing numbers but I have memory problems and I won't be able to remember to do it later.)


Mogs
.
Click to expand...
Thanks Mogs :bighug::bighug:
I'll bookmark that one too!
Thanks for correcting me! :D
 
Nan & Amber (GA) said:
:)

I think you still have to test again in 30, but we may have to adjust the strategy a bit to account for the number of strips you have. You'll be fine for today, it's just a matter of making sure you have enough to last until, what, Wednesday you think?
Click to expand...
Sasha advises correctly that the Gluconavii meter (human) has the best priced strips in the UK at the moment. Several members use this meter and have found it to be reliable.

If you have Amazon Prime then they have meter and strips available for delivery tomorrow:

Gluconavii Meter and Starter Kit £13.99 - NB: Kit only contains 10 strips.

Gluconavii Test Strips - £16.78 for 100 Strips


Mogs
.
 
Critter Mom said:
Sasha advises correctly that the Gluconavii meter (human) has the best priced strips in the UK at the moment. Several members use this meter and have found it to be reliable.

If you have Amazon Prime then they have meter and strips available for delivery tomorrow:

Gluconavii Meter and Starter Kit £13.99 - NB: Kit only contains 10 strips.

Gluconavii Test Strips - £16.78 for 100 Strips


Mogs
.
Click to expand...

Thank you, I'll have a look at this one. How do reading numbers work on a human meter? Is it that the threshold for a low number is a bit lower?

Also, just done a reading at +7.5, his BG is up to 5.3 now
 
Oscar and Carrie said:
Thank you, I'll have a look at this one. How do reading numbers work on a human meter? Is it that the threshold for a low number is a bit lower?
Click to expand...
Yep. The lower bound of the feline BG reference range at FDMB for the Alphatrak is 3.8mmol/L | 68mg/dL (not 3.7mmol/L). FDMB does not have a defined upper bound for the feline BG reference range as measured on pet meters (question for the vet).

FDMB uses 2.8-6.7mmol/L | 50-120mg/dL as the reference range for measurements of feline blood glucose levels taken on a human meter, so you would not intervene to raise BG levels unless Oscar dipped down to around the 3 mark.

FYI, all the dosing protocols in use at FDMB are written for human meters. You can post for help at any time while you're getting used to the slightly different numbers.


Mogs
.
 
Hey everyone, just got back from the vets.
She was really good about everything, and seemed very happy with all of the data I could provide.
She's agreed his dosage needs reducing straight away, and has suggested going to 1unit twice per day, with instructions that if his preshot is lower than 10, to wait for an hour, retest and only give the shot if it has come up to around 11/12.
Will monitor him on the lower dose over the next week, and he has a check up next Friday to review and adjust dose again if needed.
Thank you for everyone's help and advice today, it really does help to know people can help when it's all going wrong!
 
Nice job today, Carrie.

Remember for the future that the earlier in the cycle you get a low number, the longer and more intensitively you need to test - intervening with food/syrup/honey as required - to make sure that numbers don't drop down again. :)


Mogs
.
 
Critter Mom said:
Nice job today, Carrie.

Remember for the future that the earlier in the cycle you get a low number, the longer and more intensitively you need to test - intervening with food/syrup/honey as required - to make sure that numbers don't drop down again. :)


Mogs
.
Click to expand...

Thank you Mogs,

I'll make sure to keep doing regular testing whilst we work on reducing his dosage :)
 
With the food change, to a much lower carb wet food, we suggest you monitor more closely.
Even though your vet agreed with the dose reduction to 1U, don't be surprised if the BG levels at nadir drop even lower again over the next few cycles.

So please, keep a close eye on your lovely Oscar.
 
Deb & Wink said:
With the food change, to a much lower carb wet food, we suggest you monitor more closely.
Even though your vet agreed with the dose reduction to 1U, don't be surprised if the BG levels at nadir drop even lower again over the next few cycles.

So please, keep a close eye on your lovely Oscar.
Click to expand...

I will do, I'm planning on testing before shots, at +3, +6, +9 during the day whilst I try to get him regulated, and then +3 in the evening to catch any quick drops.

The vet has told me to send over any curves where he drops below 3.8 before his next appointment so she can keep an eye on him. I've also sent them to the link to my spreadsheet :)
 
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