? BG slowly increasing but below 200. Should I give insulin?

Status
Not open for further replies.

Diana & Martin

Member Since 2022
Hello! Martin has had a very weird (but good) day in terms of his BG levels. Yesterday his BG started raising right after his AM shot and then started decreasing around +9. I gave him his PM shot with his BG @200 and to my surprise this morning he tested 86. Stalled for 20 min and was still at 86 so I decided not to give him his shot.

He's had fantastic numbers throughout the day, so good that I don't really understand what's going on. Still, his numbers have been slowly increasing during this cycle. Now it's time for his PM shot. At 163 I don't feel comfortable giving him insulin but today's trend shows that his BG is probably going to continue slowly increasing. I'm stalling for 20 min but I don't know if he'll get to 200 anytime soon, and he's begging for food right now so I don't know how many times he'll tolerate the testing and stalling. If he doesn't reach 200, should I skip this dose as well even though levels are slowly going up?
 
He's trending up, however, I don't recommend shooting this low for the first time during a PM cycle unless you can stay up as long as needed to get some tests in to ensure he stays safe.

His body is still adjusting to completely removing all dry just a couple of days ago, it may take a couple of more cycles for him to fully settle in to this adjustment too.

It's just one cycle. The most important thing is to keep Martin safe.
 
Hi @Shelley & Jess ! Martin still seems to be going strong with his sudden improvement. I followed your advice and didn't give him his shot last night. This morning he was at 200 so I gave him the reduced dose of 0.25units that you suggested. I was a little surprised because I was expecting his BG to be higher.

I just got home from being away all day and found that Martin vomited, no plants involved this time. Vomit was liquid and a little bit of food. I took a reading and he was at 83, so I'm thinking that perhaps he dipped too low while we weren't home and that's why he vomited? It seems like we won't be giving him a shot tonight either, since it's only 3 hours from now and I don't think his BG is going to raise above 200 by then. But I'm guessing he earned a dose reduction again with that 83 if he's high enough tomorrow. Is there anything lower that 0.25 though?

I can't thank you enough for all your help, Shelley. I'm not celebrating just yet but I feel like Martin has improved soooo much in the past week I just can't believe it!
 
Update: his BG this morning was 163 before eating and 167 after. Gave him the smallest dose I could draw:


IMG_2251.jpeg
IMG_2252.jpeg
 

Attachments

  • IMG_2251.jpeg
    IMG_2251.jpeg
    50.5 KB · Views: 216
  • IMG_2252.jpeg
    IMG_2252.jpeg
    60.5 KB · Views: 223
Vet called to check in + saw the spreadsheet with latest numbers. They said to hold the current dose for 2 weeks and do another home curve then, but I feel like he hasn't been reaching high enough levels to warrant a dose at night for the past few days. Is there such a thing as shooting every 24 hours instead of 12, or is this going to affect his progress in some way? How do I know when he doesn't need insulin any more?
 
Also, about the 50% drop that you just mentioned – thanks for bringing it up because I actually had decided not to test him any more until his PMPS to give his little ears a break. Should I be keeping an eye out though?
 
Thanks for posting in your thread.

Yes, I would test again in 30 minutes to see if the drop slows down.

Prozinc onset is around +2. If he keeps dropping at the pace he's going, think about where he might end up in 1/2 hour or an hour from now.

It wouldn't hurt to feed a little LC food right now.

We don't know how much the 0.1u is influencing this cycle yet and how much his pancreas will kick in.

Make sense?
 
Thanks for posting in your thread.

Yes, I would test again in 30 minutes to see if the drop slows down.

Prozinc onset is around +2. If he keeps dropping at the pace he's going, think about where he might end up in 1/2 hour or an hour from now.

It wouldn't hurt to feed a little LC food right now.

We don't know how much the 0.1u is influencing this cycle yet and how much his pancreas will kick in.

Make sense?

Ok you were right again! BG is 69 half an hour later. What should I give him? This is what I have on hand: his regular Lily's Kitchen food, which he was just eating a couple minutes ago, shredded chicken breast that I boiled for him without salt or anything, his old super HC dry food which I'd rather not give him, the Leonardo drink pouches which I think are LC (ingredients are 84% chicken, 9% salmon, 1% minerals) , and some treats. Uploading pics of treat ingredients:

IMG_2253.jpeg
 

Attachments

  • IMG_2254.jpeg
    IMG_2254.jpeg
    79.7 KB · Views: 139
  • IMG_2253.jpeg
    IMG_2253.jpeg
    93.5 KB · Views: 220
69 is a perfectly safe number. No HC yet. I haven't calculated the carbs in the treats - but with all those potato ingredients high up in the list, probably as HC as the dry food.

The LC you just fed may be enough, test again in 30 minutes.
 
If next test doesn't look like he's slowing down enough and in the 50's you could try another tsp of LC with a drop or two of honey or syrup mixed in. This would give you MC (medium carb).

We're awful early in the cycle and still have about 3 hours until expected nadir.
 
That's perfect. The drop has stopped. Hopefully he'll surf through until nadir. I'd get a test in an hour to make sure the LC is staying with him. Sound good?
 
Vet called to check in + saw the spreadsheet with latest numbers. They said to hold the current dose for 2 weeks and do another home curve then, but I feel like he hasn't been reaching high enough levels to warrant a dose at night for the past few days. Is there such a thing as shooting every 24 hours instead of 12, or is this going to affect his progress in some way? How do I know when he doesn't need insulin any more?
We can touch on this in a bit (need to get some work done:oops:) I have an idea you could try.

In the meantime, linking (and copy/paste) a document written by @Deb & Wink and why the need for caution this morning.

Why the +2 Test is Important - more detail information for Prozinc users by Deb & Wink

More than a number range, think of the percentage of the drop at +2, that may tell you if your cat is going to drop much lower. Think of that +2 as being an indicator of what direction the BG levels may be headed.

With Prozinc, if you see a 40%, 50% or greater drop, between the pre-shot and that +2, that's a serious heads up warning.

If you see a 20-25%, 30% drop, not quite so worrisome. But still be cautious.

Your cat drops 2 color ranges between pre-shot and the +2, pull out your hypo kit and plan on staying up to test.

Your cat drops 2 color ranges between pre-shot and the nadir, that is to be expected. But you don't want the drop to be much more than 50% between pre-shot and nadir with Prozinc.

Cats tend to bounce high if the drop is 50% or more from pre-shot to nadir.

So you steer those mid-cycles with food, to slow down the steep drop and stop the bounces from being too high.

The steeper the drop, the higher the bounce.

It's a balancing act.


The +2 is like an "early warning" for most cats!

If the +2 is about the same as the PS, it's usually a pretty normal cycle...dropping down to nadir and then rising back up again. (About the same means taking meter variance, that 15% variance that hand held glucometers are allowed to have into account)

If the +2 is higher than the PS, that usually signals a bounce, and those are the cycles when you can usually take a break from testing.

If the +2 is lower than the PS, that's your "Early warning" that kitty might be going much lower later in the cycle so it's important to plan on getting another test or two (or 6) in.

It doesn’t work every time or with every cat. But it does hold true most of the time, so keep this in mind for next time.

It also kind of depends on what BG pre-shot your cat started out the cycle with. Lower than normal, keep a closer eye on the cycle. Lower than you are used to shooting, a number you may not have given insulin before, keep a closer eye on the cycle. Stalled and number rose some, but you did a reduced shot, maybe another test or 2 to see how much the number is rising.

It makes a big difference if your cat starts the cycle in the pink 300-399 mg/dL range (16.6 - 22.16 mmol/L) then if they are in the blue 150 mg/dL range ( 8.3 mmol/L).


p.s. Food notes in the Remarks column can be very useful. Helps to interpret what is happening in the cycle. Notes are done on AM and PM cycle basis and notations need to be with the + time format.


Please be aware that these are only my thoughts based on my experience. This is not a scientifically based study, nor is it a published journal article. So “buyer beware” as they say. ECID.

This was based originally on Chris & China (GA) post where she noted the information for lantus users on the +2 test and what it can mean for the rest of the cycle. I took that as a working basis, and fleshed things out quite a bit more for Prozinc users.
 
This is so useful thank you! One hour later still @65. I'm getting ready to go out for a few hours. I think we're in safe territory, no? Should I leave anything out for him besides his regular food?
 
Hello and happy Saturday! Martin's BG has been too for insulin for the past several nights as well as this morning. From what I've seen in other people's SS's they eventually start an OTJ trial when levels are consistently low, but it seems to be more gradual and intentional than how it's going with Martin. How do I know when to stop giving insulin altogether? And how much do I give next time, considering he dropped below 90 with the teeniest little drop? And how do I know when next time would be?!!
 
Martin sure looks like he's in a hurry to get off insulin!

If he keeps up with these numbers, you've already started your OTJ trial!

I'd be cautious. Keep collecting the data, watch for signs of him trending up over a period of a few cycles. If you see the odd blue at PS, don't jump the gun and shoot the first 120 you might see.

Ideally, your cat needs to have been stepping down the dosing scale, from 1 to 0.75, to 0.5, to 0.25, to 0.1 and getting good numbers all along before you attempt an OTJ trial. If the pre-shot readings drop below 100, and stay there for a few days, then you would want to stop the insulin and try what we call an OTJ trial.

The 'ideal' often doesn't happen with Prozinc, so some people go ahead with an OTJ trial anyway.

Here are the OTJ Trial Guidelines

If on Lantus or Levimir, depot has to drain first before trial starts, about 3 days or 6 cycles. No depot with in and out type insulins (NPH, Vetsulin/Caninsulin, Prozinc). The trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall. With only occasional readings in the 100 - 120 range. Start the trial on the next green pre-shot test.

1. Test at your normal AMPS and PMPS times. Remember, you want a 2 hour fast before those AMPS and PMPS test times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas). The morning test is now called the AMBG. The evening test is now called the PMBG.

2. If your cat is green (0-99 mg/dL human meter, 0-130 mg/dL pet meter, 0-5.5 mmol/L) at your normal test times, no need to test further until the next "PS" time, just feed small meals and go about your day. If the numbers are blue or higher (100-199 human meter, 130-230 pet meter, 5.5-11 mmol/L), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

3. Your cat may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

4. After 2 weeks, 14 full days, if everything is looking good, time to party!

Sometimes, the trial doesn't work the first time and we have to give a little more support by starting the cat with a tiny dose of insulin again. We simply start the cat back on a tiny dose of insulin to support the pancreas with healing for a bit longer. With just a little more time we will probably get that strong remission we are looking for.
 
Martin sure looks like he's in a hurry to get off insulin!

He does, doesn't he! My husband and I joke that when he heard all the trips we originally had lined up for the summer he made the whole diabetes thing up to keep us locked in the house with him and now that summer's coming to an end he's finally decided to release us lol :p


Here are the OTJ Trial Guidelines

2. If your cat is green (0-99 mg/dL human meter, 0-130 mg/dL pet meter, 0-5.5 mmol/L) at your normal test times, no need to test further until the next "PS" time, just feed small meals and go about your day. If the numbers are blue or higher (100-199 human meter, 130-230 pet meter, 5.5-11 mmol/L), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

Ok so just to make sure, should I stop testing throughout the day or is it still worth it to get a test or two to look out for food bumps at +3 or +4?
 
He does, doesn't he!
No doubt about it now - two more beautiful GREEN preshots!!
How do I know when to stop giving insulin altogether? And how much do I give next time, considering he dropped below 90 with the teeniest little drop? And how do I know when next time would be?!!
I'd be cautious. Keep collecting the data, watch for signs of him trending up over a period of a few cycles. If you see the odd blue at PS, don't jump the gun
He also hasn't given us time to 'ease' in to the answers either, I was answering the how & when here and included the OTJ trial guidelines for the just in case scenario.
Ok so just to make sure, should I stop testing throughout the day or is it still worth it to get a test or two to look out for food bumps at +3 or +4?
Looks like he's ready to go for it!

Follow the OTJ Trial guidelines for testing - no need for mid cycle tests if he's green at AMBG/PMBG.

GO MARTIN GO!!!
 
Status
Not open for further replies.
Back
Top