Bug- numbers have come down but still lethargic and seems to not feel well

HeathSesh

HeathSesh

Member Since 2023
Hello,

Luckily Bug’s numbers have come down and he’s been in the 100-200 range for a little over a week now, but he still remains pretty lethargic and unsteady on his feet. His thirst and urination is more normal and for the most part his appetite is still good, but I can tell he’s not feeling well and almost seems to be feeling worse than when his numbers were very high. I’m sure it’s different for every cat and can take some time to recover from hyperglycemia but is there a general time frame of when you can expect to see them start to feel better than they did when they were unregulated? I realize his age and CKD are definitely contributing factors.

Thanks,
Heather
 
Hi. I am very concerned you are not testing before every dose to see it is safe to give the dose. It is very possible Bug is getting insulin when his blood glucose it too low…and he is exhibiting symptoms of hypoglycaemia.
Being unsteady on his feet and lethargy are signs of hypoglycaemia.
If you are not testing during the cycles you have no idea how low the dose is taking Bug.
Glargine dosing is based on the nadir or the lowest point in the cycle….not the preshot BG

I would recommend you start testing before every dose. And again at least once during every cycle to see how low the dose is taking Bug.
On 1/4 he got an 81 at +4 and a few days later you increased the dose. I would not have done that.
Personally I would reduce the dose back to 4 units and I would start tests as I suggested above.

How often are you feeding him?
 
Thank you for your reply! You're exactly right, I need to be more consistent about testing daily both preshot and during the cycles and get on that. How many hours into the cycle do you usually recommend testing?

He eats most of his food every 12 hours preshot but doesn't usually eat it all and will go back to finish it within a couple of hours.
 
HeathSesh said:
How many hours into the cycle do you usually recommend testing?
Click to expand...
The first 6 hours is usually when the insulin is strongest…..but not always. So you do need to be guided by the BG numbers.
If the BG numbers are starting to rise after the 6 hours, then it is probably safe to not test until the next preshot. If the BG numbers are still dropping I would keep testing until they start to rise.


HeathSesh said:
He eats most of his food every 12 hours preshot but doesn't usually eat it all and will go back to finish it within a couple of hours.
Click to expand...
I would make sure he eats some snacks during the cycles (both day and night cycles) as food can stop the BGs from dropping too low.
I think if you feed him more during the cycles…up til about +8….you will find he will feel better.
But I do think you need to reduce the dose of insulin until you establish that he is not dropping too low as I suspect he is at the moment.
Please post each day so we can help you.:)

Do you have a hypo box set up in case it is needed and do you know what you look for in a hypo?
Here is a link to the hypo box

HYPO BOX AND HOW TO TREAT A HYPO
 
Last edited:
I see Bug came out of remission in December 22. How did you reach 4 units so quickly?

I think I would be inclined to drop the dose to 3.5 units until you get some mid cycle and preshot tests in to see how low the BG is dropping.
I’ll ask @tiffmaxee and @Wendy&Neko what they think about the dose.
 
Ok great. I’ll do some testing around +6 and see how the numbers are changing and do some meals during cycles as often as I can. Unfortunately my work schedule doesn’t always allow me to feed multiple times a day but between my husband and me, I think we can make it happen most days.

Yes I do have a hypo box ready to go as well as the symptoms and instructions posted on the fridge.

I increased his dose so rapidly on the advice of our vet. The vet recommended we start him at 2u in December since he stabilized well after initial diagnosis in 2021 at that dose. Through December his BG numbers stayed in the 400-500 range consistently so vet said to increase by 0.5u every few days until they come down. After reading extensively on the website and forums, I learned that most likely wasn’t the best approach but didn’t feel like I should mess with the dosage too much since I was seeing BG numbers drop on 4.25u dosage. But with his current symptoms, my inconsistent testing, and your advice, I’m seeing that lowering the dose is the best approach at this point. Do you recommend I drop the dosage over time? Or go ahead and drop immediately to 3.5u in the AM tomorrow? His PMPS this evening was 387.
 
HeathSesh said:
Ok great. I’ll do some testing around +6 and see how the numbers are changing and do some meals during cycles as often as I can. Unfortunately my work schedule doesn’t always allow me to feed multiple times a day but between my husband and me, I think we can make it happen most days.

Yes I do have a hypo box ready to go as well as the symptoms and instructions posted on the fridge.

I increased his dose so rapidly on the advice of our vet. The vet recommended we start him at 2u on 12/13/22 since he stabilized well after initial diagnosis in 2021 at that dose. Through December his BG numbers stayed in the 400-500 range consistently so vet said to increase by 0.5u every few days until they come down. After reading extensively on the website and forums, I learned that most likely wasn’t the best approach but didn’t feel like I should mess with the dosage too much since I was seeing BG numbers drop on 4.25u dosage. But with his current symptoms, my inconsistent testing, and your advice, I’m seeing that lowering the dose is the best approach at this point. Do you recommend I drop the dosage over time? Or go ahead and drop immediately to 3.5u in the AM tomorrow? His PMPS this evening was 387.
Click to expand...
I think the vet had you increase too quickly and by too much and you could have gone past the best dose.
I would drop the dose at the next preshot.
While the BG numbers look as if they are lower…..you haven’t been doing enough testing to see if Bug is bouncing after lower BGs as there are too many holes in the SS.
I think he has been dropping low and then bouncing up high.
Here is an explanation about bouncing from the Basics in the lantus page.
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
As a precaution, I would also get a bottle of ketostix from Walmart or a pharmacy, if you don’t already have any, and test the urine for ketones. You just need to get a sample of urine from Bug and dip the test strip into the urine and read it against the colours on the side of the bottle exactly 15 seconds later. There should be no ketones.

Have you thought about an automatic timed feeder to feed Bug when you are not there?

Don’t feed for the 2 hours before the pre shot BGs as we like them to not be food influenced.
 
I dropped his AMPS to 4u and will see how his BG look from here to determine whether I should drop even lower. Unfortunately today my husband and I are both gone all day so I won’t be able to test during the cycle. We have three dogs, two of who are agile enough to jump on any counter or shelf that has cat food on it so I haven’t considered an automatic feeder. I do have Ketostix and have tested Bug once a week for the past few weeks with no signs of ketones. I’ll check again tomorrow.

I’m considering switching to a human meter as I’m sure the test strips are more affordable. One of the reasons I’ve been inconsistent with testing is that the AlphaTRAK2 test strips are so pricey.. $1 a piece! I like that it requires such a tiny drop of blood and was told by our vet to only use a meter for animals but I see on here that human meters are recommended. Can you explain to me why and possibly recommend a quality human meter that requires only a small amount of blood?

Thank you for your help, advice and prompt replies! I really appreciate it
 
Most people find they can test a lot more when they switch to a human meter, for exactly the reason you say - too pricey! Plus, it's easier to get more test strips at your local pharmacy when you are running low. One you have a better/cheaper supply of test strips, you'll be able to test more often and keep him safe. Like Bron, I'm concerned the unsteady on feet corresponds with lower numbers. It is true that cats get used to being in higher numbers and it does take some time for them to get used to lower numbers. But that doesn't mean unsteady. Neko started out playing in low 300's, then eventually worked her way down to playing when in the low 100's/high greens.

Are you still planning on following SLGS as per your signature? That 81 you got on Jan 4th would mean you reduce the dose from 4 units, not increase. With SLGS, you reduce the dose everytime you spot something under 90. Good catch that day by the way!

I'd be testing before every shot, spot checks during the days you are home, and a test right before you go to bed. It is possible that 4 units is still too much insulin, and the numbers will tell you if that's so.
HeathSesh said:
. Can you explain to me why and possibly recommend a quality human meter that requires only a small amount of blood?
Click to expand...
Back before the company that made AlphaTrak started heavily marketing it to vets, everyone used human meters, even the vets. Our dosing protocols were written back then, and use data from human meters. One of the few peer reviewed and published dosing protocols (Tight Regulation) was also developed back then. I don't think vets really understand how much the test strips really cost. In the US, I think a lot of people here use the Relion Premier from Walmart. I know the Freestyle Lite is similar to the AT and needs the same size blood drop, and that is commonly used in Canada. However, the price of test strips is more than the Relion ones, which unfortunately we cannot get in Canada.
 
Wendy&Neko said:
Most people find they can test a lot more when they switch to a human meter, for exactly the reason you say - too pricey! Plus, it's easier to get more test strips at your local pharmacy when you are running low. One you have a better/cheaper supply of test strips, you'll be able to test more often and keep him safe. Like Bron, I'm concerned the unsteady on feet corresponds with lower numbers. It is true that cats get used to being in higher numbers and it does take some time for them to get used to lower numbers. But that doesn't mean unsteady. Neko started out playing in low 300's, then eventually worked her way down to playing when in the low 100's/high greens.

Are you still planning on following SLGS as per your signature? That 81 you got on Jan 4th would mean you reduce the dose from 4 units, not increase. With SLGS, you reduce the dose everytime you spot something under 90. Good catch that day by the way!

I'd be testing before every shot, spot checks during the days you are home, and a test right before you go to bed. It is possible that 4 units is still too much insulin, and the numbers will tell you if that's so.

Back before the company that made AlphaTrak started heavily marketing it to vets, everyone used human meters, even the vets. Our dosing protocols were written back then, and use data from human meters. One of the few peer reviewed and published dosing protocols (Tight Regulation) was also developed back then. I don't think vets really understand how much the test strips really cost. In the US, I think a lot of people here use the Relion Premier from Walmart. I know the Freestyle Lite is similar to the AT and needs the same size blood drop, and that is commonly used in Canada. However, the price of test strips is more than the Relion ones, which unfortunately we cannot get in Canada.
Click to expand...

Yes I plan to continue following the SLGS method. However I dropped Bug down to 3.5u this morning. I'm leaving town this weekend and worry about keeping him on the 4u since the suspicion is even that dose may be too high. My husband will be home with him to give insulin and may try to test but he's not super comfortable with any of the needle related tasks and Bug can be a challenge to test alone. So I figured dropping him down to 3.5u would be the same route to go.

Thank you for the explanation and information on meters. I'll look into the Relion Premier or Freestyle Lite and switch over so it's more affordable to test consistently!
 
I’ll be away 4 days. I do have a hypo box ready to go and printed out the symptoms and treatment sheet from the forum post on hypoglycemia and have it posted on the fridge. I’ve educated him and he knows what to look out for. Luckily he’s off work and home those 4 days and can keep an eye on him 24/7.
 
You must log in or register to reply here.
Back
Top