Angel diving lower and lower

Lisa and Angel

Lisa and Angel

Active Member
https://www.felinediabetes.com/FDMB/threads/angels-near-hypo.279959/

What on Earth is going on? This is the 3rd low in a week, and the lowest one so far.

I'm dealing with the lower numbers, however. I'd like to know:

1. How much should I reduce her with the next shot (I suspect I'll have to skip the AM shot again, but after that when her preshot levels are okay again)? 0.25 again, or maybe more?

2. Her current vial of prozinc is nearly empty, so I'll have to start another soon. I've read in the stickies that new vials of insulin are more potent at first; should I reduce preemtively when I draw from the new vial (somewhere in the next few days I think)?
 
I see she’s up to 67. Give her a spoonful of low carb food and test again in 20-30 minutes. You must make sure she doesn’t drop back down. The rule is to keep testing for 2 hours after anything high carb is given. If she’s dropping back down then you will have to use higher carb.
 
Hi, I kept the spreadsheet up to date. 2.1 was the lowest she went, the honey kicked in quickly- she's at 4.6 now. But I'll keep monitoring her in case she goes back down. She gets a snack after every test :) and I have everything from the hypo kit on standby.
 
Okay. You are not around and I have to go. I have I have been checking her spreadsheet and I see that you have gotten more tests and she has gone up more. I have a few questions for you. I would like to know what she ate. I don’t need to know the names of the foods just was it low carb medium carb, high carb and what time in the cycle she ate. I feel like a broken record, but it’s very important for her to have snacks in the early part of the cycle possibly throughout the evening a lot of people use timed automatic feeders for this purpose. She needed to get a test long before the test that she had in tonight cycle, which was way too late and she was already in the lime green. She should’ve had a plus to test to see if she had dropped from the preshot test. If she’s about the same at +2 that’s good , if she’s dropped a lot you need to intervene at that point in time at the very latest I would recommend a +3 test on Angel before you go to bed. If she is dropping a lot then you will need to set alarms to wake up to test her in the nighttime cycle. I am sure I have some more questions but this kind of sums up what I’m seeing when I look at her spreadsheet, please read through my other comments above this one I have to run out really fast I’m going to be late as it is for my evening appointment and I have to go, but I will check in later in a couple of hours. I’m glad to see that she is doing better now.
 
Oh, and I am sorry if the message above is garbled or doesn’t have any stops or punctuation in it. I am text talking on my phone right now, which is some thing I hate doing, but I am in a huge hurry, but I will check in in a couple of hours after I get back home.
 
Suzanne & Darcy said:
Okay. You are not around and I have to go. I have I have been checking her spreadsheet and I see that you have gotten more tests and she has gone up more. I have a few questions for you. I would like to know what she ate. I don’t need to know the names of the foods just was it low carb medium carb, high carb and what time in the cycle she ate. I feel like a broken record, but it’s very important for her to have snacks in the early part of the cycle possibly throughout the evening a lot of people use timed automatic feeders for this purpose.
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She is freefed dry high carb. I know it's not great, but I've tried every low carb dry available in my region and they all gave her horrific diarrhea (and I mix the new food in verryyy slowly). She has a very sensitive tummy and only does well on her current food (Royal Canin Digestive Care, ~27% carb). I've tried many wet low carbs too, and ditto with the diarrhea if she gets more than 1 small can a day. Even tried the veterinary diabetes diets, which I know aren't great either with higher carbs, but I figured they'd be better than regular food. No dice either, diarrhea once again.

Usually she also gets half a can of wet food (often low carb, but sometimes high) a day, but I've stopped that since her latest bout of diarrhea to give her stomach time to settle.

She eats at least once every hour from what I can see when I'm awake. Whenever she gets a snack, she'll always grab a bite of dry afterwards as well. So she has frequent small meals even in the early part of the cycle.

During her shots she gets a bit of liquid snack (also high carb). Whenever I test her, she also gets a treat; sometimes liquid snack, sometimes something else.

Suzanne & Darcy said:
She needed to get a test long before the test that she had in tonight cycle, which was way too late and she was already in the lime green. She should’ve had a plus to test to see if she had dropped from the preshot test. If she’s about the same at +2 that’s good , if she’s dropped a lot you need to intervene at that point in time at the very latest I would recommend a +3 test on Angel before you go to bed. If she is dropping a lot then you will need to set alarms to wake up to test her in the nighttime cycle. I am sure I have some more questions but this kind of sums up what I’m seeing when I look at her spreadsheet, please read through my other comments above this one I have to run out really fast I’m going to be late as it is for my evening appointment and I have to go, but I will check in later in a couple of hours. I’m glad to see that she is doing better now.
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I know, and I'm kicking myself for it. I'd planned to get a +5 but she was frolicking in the garden and looking really happy, so I didn't want to disturb her. I didn't think she's be so very low. Her poor ears are really sensitive from all these tests, and she's so done with me atm. But I will do what needs to be done.

During the AM cycle, with the +3 drop, I did set an alarm to get up (I shoot at 2am and 2pm due to my shift work sleep schedule). But she'd gone back up again, which reassured me. Didn't expect this huge drop, though I notice she's often lower during the PM cycle so I'll have to pay extra attention then.

Suzanne & Darcy said:
I am sure I have some more questions but this kind of sums up what I’m seeing when I look at her spreadsheet, please read through my other comments above this one I have to run out really fast I’m going to be late as it is for my evening appointment and I have to go, but I will check in later in a couple of hours. I’m glad to see that she is doing better now.
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No problem, ask anything that comes to mind. Thank you very much for responding here even when strapped for time!

PS: do you have any advice for her sore ears?
 
Suzanne & Darcy said:
Oh, and I am sorry if the message above is garbled or doesn’t have any stops or punctuation in it. I am text talking on my phone right now, which is some thing I hate doing, but I am in a huge hurry, but I will check in in a couple of hours after I get back home.
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I don't mind at all! Just glad to read your reply. I will be awake for at least another 3 hours, after that I might go to sleep IF her tests are looking good. Will keep her spreadsheet up to date, I expect I'll have to skip the next shot anyways unless she skyrockets soon.
 
Hmm, 9.9 at preshot time. Unsure of whether I'll skip or shoot a reduced dose. I think I'll wait for a bit at first and then retest, see if she'll go higher.
 
1.5 hours later and she's at 8.9. So, I'll be skipping the shot. Going to bed soon but I'll check back for comments when I wake up. :)

Edit: 8.6 I misremembered.
 
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Another question: some fur was shaved off for the first libre back in April, the fur there has not grown back. She had an ultrasound done in May, the fur there hasn't grown back either. We assume it's due to the diabetes, but is there anything we could do to help it grow again? Vet has no tips, says we'll have to wait and see if it'll grow back once she's regulated. I've noticed a few tiny patchy wisps of fur there recently, but no real growth.

I found this old thread: https://felinediabetes.com/FDMB/threads/slow-no-fur-growth-diabetes-related.157134/ where someone recommends B-complex supplement/Zobaline. Zobaline isn't available in my region, but other methylcobalamin pills are. Do you think this would help?
 
I think she should be okay. It is hard to tell when her nadir is, though, because we don't have a lot of data on that which is recent. Yesterday, she went lowest in the +7/+8 time frame. If she's eating/snacking, then she should be okay, I think. What do you think?
 
Lisa and Angel said:
Another question: some fur was shaved off for the first libre back in April, the fur there has not grown back. She had an ultrasound done in May, the fur there hasn't grown back either. We assume it's due to the diabetes, but is there anything we could do to help it grow again? Vet has no tips, says we'll have to wait and see if it'll grow back once she's regulated. I've noticed a few tiny patchy wisps of fur there recently, but no real growth.

I found this old thread: https://felinediabetes.com/FDMB/threads/slow-no-fur-growth-diabetes-related.157134/ where someone recommends B-complex supplement/Zobaline. Zobaline isn't available in my region, but other methylcobalamin pills are. Do you think this would help?
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Have you had any lab work done on her lately? I assume you did back in April when she was diagnosed. It could definitely be the diabetes. And giving either a B-Complex supplement and/or some Zobaline could possibly help. It would be worth a try. I have given several of my cats Jarrow B-Right B-complex in capsules (dividing one human capsule into ten #4 size capsules). It doesn't have to be Zobaline if you want to try supplementing methylcobalamin. It can just be methylcobalamin. Perhaps it would help her neuropathy even though it pre-dates her diabetes diagnosis and seems unrelated.
 
Since yesterday, I've been thinking about why she's sometimes doing these dives into lime green. I think it's the high carb food. I know that you've been trying other foods with her, so I understand. And boy do I understand about cats with diarrhea (unfortunately) so I know that, for now, you are doing the best that you can -- and she needs to eat. The frequent eating of the high carb food puts her in a situation where it keeps her BG pretty high. The insulin is working to try to lower the BG. So if she's away from her food for a while (like outside playing, sleeping, etc.) or for any other reason just not eating for a while, that puts her in a position where she can drop quite low. You would have to tell me if you think that may be what has happened in the past. So with her eating the HC food, you may have to find a dose that will lower her BG somewhat, but not into what we would consider "optimal" levels, due to the fact that she could drop too low if she stops eating (especially if you are not around to monitor her.) And you can keep trying to see if there's any lower carb food that she can tolerate without getting diarrhea -- even a bit lower or a medium carb type food -- and anything under ten percent is still considered low carb, remember. It's really rough, I know.
 
Yeah, I think she won't go much lower now. And I think she'd appreciate the break
Suzanne & Darcy said:
I think she should be okay. It is hard to tell when her nadir is, though, because we don't have a lot of data on that which is recent. Yesterday, she went lowest in the +7/+8 time frame. If she's eating/snacking, then she should be okay, I think. What do you think?
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Yeah, I think so too.
 
Suzanne & Darcy said:
Have you had any lab work done on her lately? I assume you did back in April when she was diagnosed. It could definitely be the diabetes. And giving either a B-Complex supplement and/or some Zobaline could possibly help. It would be worth a try. I have given several of my cats Jarrow B-Right B-complex in capsules (dividing one human capsule into ten #4 size capsules). It doesn't have to be Zobaline if you want to try supplementing methylcobalamin. It can just be methylcobalamin. Perhaps it would help her neuropathy even though it pre-dates her diabetes diagnosis and seems unrelated.
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Not since April, no. I think I'll try the methylcobalamin, it would be great if it incidentally also helps with her neuropathy.
 
Suzanne & Darcy said:
Since yesterday, I've been thinking about why she's sometimes doing these dives into lime green. I think it's the high carb food. I know that you've been trying other foods with her, so I understand. And boy do I understand about cats with diarrhea (unfortunately) so I know that, for now, you are doing the best that you can -- and she needs to eat. The frequent eating of the high carb food puts her in a situation where it keeps her BG pretty high. The insulin is working to try to lower the BG. So if she's away from her food for a while (like outside playing, sleeping, etc.) or for any other reason just not eating for a while, that puts her in a position where she can drop quite low. You would have to tell me if you think that may be what has happened in the past. So with her eating the HC food, you may have to find a dose that will lower her BG somewhat, but not into what we would consider "optimal" levels, due to the fact that she could drop too low if she stops eating (especially if you are not around to monitor her.) And you can keep trying to see if there's any lower carb food that she can tolerate without getting diarrhea -- even a bit lower or a medium carb type food -- and anything under ten percent is still considered low carb, remember. It's really rough, I know.
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I guess that's possible, I don't recall exactly when she ate over the last few days, though I'll keep an eye out and try to write down her eating moments tomorrow to see if there's a connection. And I'll keep looking for a new lower carb food.

Do you think it's possible that she's starting to produce her own insulin again? Looking at the past few days, she's much lower than normal even after a skipped shot. Like on the 30th she was 8.6 at PMPS even though it had been 24 hours since her last insulin shot. And today same at 12.6, also lower than normal and 24 hours since last shot. I've also noticed that she's not bouncing much or at all anymore, even after those lime greens from last night she hasn't even hit a pink.
 
Lisa and Angel said:
I guess that's possible, I don't recall exactly when she ate over the last few days, though I'll keep an eye out and try to write down her eating moments tomorrow to see if there's a connection. And I'll keep looking for a new lower carb food.

Do you think it's possible that she's starting to produce her own insulin again? Looking at the past few days, she's much lower than normal even after a skipped shot. Like on the 30th she was 8.6 at PMPS even though it had been 24 hours since her last insulin shot. And today same at 12.6, also lower than normal and 24 hours since last shot. I've also noticed that she's not bouncing much or at all anymore, even after those lime greens from last night she hasn't even hit a pink.
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I honestly do think that she is making progress. I’m very happy to see it! That’s all the more reason why you must keep a close watch on her. Cats can be very surprising at these times.
 
I think I'll just give a token dose of 1U. Don't really want another hypo and I'm not sure I can monitor her all night (feeling like absolute crap, I fear I might sleep through any alarms I'll set).
 
Not sure tbh. I think it's a good sign that she's still in the yellows even with only 1U, but no noticable nadir last cycle. Still, 12.6 is a great preshot level right?

Do you think I could start with a +5 test today?
 
If I were trying to not do too many tests, I would get a +3 and a +5. The plus 3 should tell you if it will be an active cycle. By that time the PZ should have kicked in and be reducing her BG.
 
Alright, I just did the +3, she's at 10.4 now. So she went down. Does that mean an active cycle? Yesterday she was higher at +3 than preshot, and she had a blue nadir.
 
Welp, 4.7 at preshot time so that's another skip! Crazy cat, she never ceases to surprise me. That's 5 skips and 2 delays in a little over a week.

This also means she's earned yet another reduction for tomorrow, right?
 
:)
Lisa and Angel said:
Welp, 4.7 at preshot time so that's another skip! Crazy cat, she never ceases to surprise me. That's 5 skips and 2 delays in a little over a week.

This also means she's earned yet another reduction for tomorrow, right?
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Yes. Since she dropped below 90, according to SLGS, she should receive another reduction of .25 units. New dose going forward is 3.25 units. :)
 
Great! :cat: thanks for all your help, this has been pretty stressful/scary and it's nice to know that there's someone helping us along.


Shot 3.25 today, she was 16.4 at PMPS. Little higher than it's been the last few days, but still yellow.
 
At least she stayed yellow after the skipped shot the previous cycle. Perhaps a very small token dose would have been okay. Gradually, as you have more data, you will be able to lower the pre-shot number where you know it's okay to shoot the full dose. Remember, you're not really shooting the AMPS or PMPS numbers, but you are shooting where she will be at her onset time. So for a lot of cats that's +2 with ProZinc. With Angel, she tends to onset later. That's another good reason to have data for the +3.
 
Yeah, I think with time it'll be easier to know what to do and how she'll respond. Though shooting that low sounds terrifying to me.:nailbiting: Mostly because with some of the skipped shots she barely went up at all.

She was at 12.3 for AMPS, so I shot full dose. We'll see how that goes. I just read the doc about how the +2 is useful to predict how the cycle will go, I'll aim for a +3 then in her case. Just for my information, would a +2 still be useful data, or not at all because of the late onset?
 
So, questionable preshot today, but I decided to go for it with full dose. I can monitor the whole cycle, and the similar preshot on the 30th leads me to think that a reduced dose isn't necessary at this preshot value quite yet.
 
Question: I'm having a harder and harder time with getting blood from her ears recently. In the beginning, she bled a lot. I have the Freestyle Lite Lancet Device, and in the beginning I'd shoot on depth setting 2, and I'd get a nice fat drop, usually right away but always within 3 tries.

Now though? We're at depth 4 (as deep as it'll go), I alternate ears, warm her ear beforehand, shoot on the vein, but a lot of the time NOTHING is coming out. When it does bleed, it's only a tiny little bit. In the past few days, it's taken about 10 tries to get a decent sized drop. Obviously this distresses her, and me, and wastes a lot of materials too.

Does anyone know what's causing this? Is it scarring from the frequent testing? Is there anything I can do? She used to let me test her easily, but she's starting to hate it now and I can't even blame her.

(Also posting this in Feline Health for visibility)

Edit: also, I don't know if this matters, but in the beginning I didn't even have to warm her ears. I don't recall if she just always had warm ears or it didn't matter to the testing. But now she pretty much always has cold ears and I always have to warm them up beforehard.
 
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This question specifically aimed at @Suzanne & Darcy
Another thing I've been wondering about lately... once her diarrhea fully clears up, I want to start giving her wet again (one meal a day, usually in the evening so around PM nadir). Just for general wellness and happiness and moisture content, in addition to her freefed dry, not replacing it. I still have lots of low carb (and also plenty of high carb) wet food.

But I've been thinking about your theory about how it's possible that the high carb food takes her high and then, when she doesn't eat for a few hours, makes her dive. Wouldn't this also be the case if I give low carb wet? She'll absolutely stuff herself on wet because she loves it, and then certainly won't eat dry for a couple hours after. Putting her in the same situation. Going up and down like a yo-yo.

If so, should I not give her low carb wet? Maybe add a bit of high carb treat? Or maybe experiment to see if the theory proves true? I'd love to hear your thoughts on this.
 
Lisa and Angel said:
Wouldn't this also be the case if I give low carb wet? She'll absolutely stuff herself on wet because she loves it, and then certainly won't eat dry for a couple hours after.
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Hi! Low carb wet food won't spike her blood glucose like the high carb food does (either wet or dry). Low carb food keeps them on a more even keel with regard to their BG overall -- some cats get a small food bump which goes away after an hour or so, some cats will get no measurable impact on BG with low carb at all. Some cats are very carb sensitive and you can measure a difference between when you give them a 3 percent carb and a 7 percent carb food. In some cats, that would not make a difference. It's good to know how carb-sensitive your cat is by testing before and after food (30 minutes after and an hour after). But anyway, the bottom line is that LC food does not have the same impact on her BG as HC food does. Now, having said that, any cat who isn't eating or goes without food for some hours can have their BG drop lower than you want it to at times.
 
Lisa and Angel said:
Question: I'm having a harder and harder time with getting blood from her ears recently. In the beginning, she bled a lot. I have the Freestyle Lite Lancet Device, and in the beginning I'd shoot on depth setting 2, and I'd get a nice fat drop, usually right away but always within 3 tries.

Now though? We're at depth 4 (as deep as it'll go), I alternate ears, warm her ear beforehand, shoot on the vein, but a lot of the time NOTHING is coming out. When it does bleed, it's only a tiny little bit. In the past few days, it's taken about 10 tries to get a decent sized drop. Obviously this distresses her, and me, and wastes a lot of materials too.

Does anyone know what's causing this? Is it scarring from the frequent testing? Is there anything I can do? She used to let me test her easily, but she's starting to hate it now and I can't even blame her.

(Also posting this in Feline Health for visibility)

Edit: also, I don't know if this matters, but in the beginning I didn't even have to warm her ears. I don't recall if she just always had warm ears or it didn't matter to the testing. But now she pretty much always has cold ears and I always have to warm them up beforehard.
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I've been away for a little while. Did you get some good replies over on the feline health forum? Did anyone send the photo of where you really should be trying to poke == outside of that vein (in other words not aiming for the vein itself?) I never did use a lancing device because I was afraid that the noise would scare my cat -- so I just did it free hand and used very tiny lancets -- but in the beginning I did use a slightly larger lancet.
 
Suzanne & Darcy said:
I've been away for a little while. Did you get some good replies over on the feline health forum? Did anyone send the photo of where you really should be trying to poke == outside of that vein (in other words not aiming for the vein itself?) I never did use a lancing device because I was afraid that the noise would scare my cat -- so I just did it free hand and used very tiny lancets -- but in the beginning I did use a slightly larger lancet.
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Yes I did! And I didn't get sent the photo, but I found it myself (I assume this: http://www.felinediabetes.com/images/laur_danny_famoussweetspot.jpg is the one you mean?). I feel very foolish because I did aim for the vein itself once it started getting harder to get blood. I've tested in "the sweet spot" a few times now and did get blood a lot easier. Hopefully she'll forget the pain of the vein pricks soon :(
 
Suzanne & Darcy said:
Hi! Low carb wet food won't spike her blood glucose like the high carb food does (either wet or dry). Low carb food keeps them on a more even keel with regard to their BG overall -- some cats get a small food bump which goes away after an hour or so, some cats will get no measurable impact on BG with low carb at all. Some cats are very carb sensitive and you can measure a difference between when you give them a 3 percent carb and a 7 percent carb food. In some cats, that would not make a difference. It's good to know how carb-sensitive your cat is by testing before and after food (30 minutes after and an hour after). But anyway, the bottom line is that LC food does not have the same impact on her BG as HC food does. Now, having said that, any cat who isn't eating or goes without food for some hours can have their BG drop lower than you want it to at times.
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Yes, but that's the worry isn't it? It's been a while so I'll just quote the bit I'm talking about:

Suzanne & Darcy said:
Since yesterday, I've been thinking about why she's sometimes doing these dives into lime green. I think it's the high carb food. I know that you've been trying other foods with her, so I understand. And boy do I understand about cats with diarrhea (unfortunately) so I know that, for now, you are doing the best that you can -- and she needs to eat. The frequent eating of the high carb food puts her in a situation where it keeps her BG pretty high. The insulin is working to try to lower the BG. So if she's away from her food for a while (like outside playing, sleeping, etc.) or for any other reason just not eating for a while, that puts her in a position where she can drop quite low. You would have to tell me if you think that may be what has happened in the past. So with her eating the HC food, you may have to find a dose that will lower her BG somewhat, but not into what we would consider "optimal" levels, due to the fact that she could drop too low if she stops eating (especially if you are not around to monitor her.) And you can keep trying to see if there's any lower carb food that she can tolerate without getting diarrhea -- even a bit lower or a medium carb type food -- and anything under ten percent is still considered low carb, remember. It's really rough, I know.
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If the high carb generally keeps her BG high, but she doesn't get the high carb for a while (away from food like before OR potentially filled up her belly with low carb wet) she can drop low.
 
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