? Cat coming off near hypo (BG 48 at midday) during BGC, need review & advice

Mariella & Simba

Mariella & Simba

Member Since 2018
Hello. I haven't posted for a few years, but could use advice from those experienced in cats coming down from a near hypo event. My Simba (my profile is not up-to-date re his history), was dx'd with heart disease about 5 weeks ago. His diabetes was stable on 2u daily until then for at least 18-24 months, and then began to go into the 300-400's. After spot checks from 11-17/18, and a curve on 11/18 (readings 392, 437, 394, 460). I increased his dose by .5u to 2.5u on 11/18. His routine bloodwork on 11/22 showed BG of 479, and a fructosamine reading of 452. This seemed to indicate that his getting heart disease (AFib), and accompanying meds, had somehow disregulated him. A spot check on12/3 was 393. I did a curve on 12/5 with readings of 357, 337, 339, 401. He was scheduled for another fructosamine test next week, but I postponed it, and have started a BGC today, 12/10. The first reading was 130 at 8:30am. The second, at 12:30pm was 48. I was very worried and even though I have 3 elder diabetic cats for a few years, had not actually lived through a hypo event. I quickly reviewed my hypo kit and printed guidelines from this group, and administered karo syrup to his gums and fed a high gravy Fancy Feast meal, followed by some high carb Royal Canin kitten food he loves. I tested again at 1pm and his BG was up to 66, and at 1:30 had come up to 141. However, when I tested again at 3:40, it had dropped to 67/73 (I used AlphaTrak test strips, one set had expired in June of 2023 (the 67 reading) and the other set expires next month (the 73 reading). I feared a flaw in the strips.

I just tested again, 6pm, and BG was 116. I now need your thinking on how to proceed the rest of the evening. I would normally test again at 8:30 and administer insulin. I have absolutely no desire to administer a normal dose, since the guidance says their insulin sensitivity can increase after a hypo incident. I am in a bit of a quandary about administering any at all, or if so, what dose, maybe half his 3.0u, 1.5u?

I have an odd theory about what might be happening, which is there was a brief few days between the high readings, during 11/24-26, when his numbers on spot tests were 167 and 188. I was wondering if his then insulin depot had kicked in to support the high readings, became depleted, and then at this time they have shot back up again, because maybe the depot is depleted again? No idea if this could be happening.

Any and all thoughts are very welcome, thank you. I haven't posted in years, please forgive any lack of proper format of the message. I will look at my profile and update it.

Mariella & Simba
 
Sorry he’s no longer stable. Sounds like you weren’t testing daily. Is that correct? Can you set up a spreadsheet and plug in whatever data you have for tge last one or two weeks? Are you still feeding the same dry food? Both are high carb.
Did he have a symptomatic hypo or just low bg? There’s a big difference.
 
tiffmaxee said:
Sorry he’s no longer stable. Sounds like you weren’t testing daily. Is that correct? Can you set up a spreadsheet and plug in whatever data you have for tge last one or two weeks? Are you still feeding the same dry food? Both are high carb.
Did he have a symptomatic hypo or just low bg? There’s a big difference.
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Thank you. Yes, you are correct, I wasn't testing daily, as in tight regulation. And, Simba has been asymptomatic all day, so I guess that is a good thing, just low bg. All 3 cats were so stable, and I have had a health challenge of my own since last spring, and I lost my discipline in their care, as far as more frequent testing, curves, recordkeeping, etc. When they are stable I have never tested before every dose, although do recognize that is the very safest thing to do. I always used the SLGS method.
So, tonight at 8:45pm he was at bg247, no doubt due to our fear he would tank again and giving more high carb foods thru the afternoon and evening. We decided to give him 1u of glargine and keep an eye on him overnight. Due to his pattern today, I think his nadir would have been probably somewhere between 12:30 and 3:30 on his curve.
Yes, I do know the prescription food is high carb. We adopted our third diabetic cat in June of last year, who is an incredibly picky eater, and hooked on dry food and dry treats. The boys comingled, for a while, and Simba quickly began to eat the new one's dry food. That one won't even eat diabetic dry food at all anymore, and hardly any wet at all. He eats RC kitten, a horrible food for a diabetic. He is low and stable right now on 3/4 unit, probably won't last forever. He was dx'd in June '22, and we had one diabetic cat already, so we agreed to adopt him, because the rescue had no resources to treat a diabetic cat. Our little girl was dx'd diabetic in August '22, to make 3.
So, we just this week completely separated the boys, as the new one has become hostile to Simba and chases him, and with his AFib he surely doesn't need the stress, so they are completely separate. That gives me the chance to once again get Simba's diet under better control. The Royal Canin Glycobalance is gone as of tonight, and he doesn't really like the Purina DM, although his little girl roommate eats it when her wet food runs low. I will get both of them off it over the next month or so. For the foreseeable future, at least a week, I will test before every shoot, as his erratic bouncing is dangerous and I need to try to get ahead of it, although with his bg at 130 this morning, I thought it would be safe to shoot, but probably shouldn't have given the 3u dose. Since I have tightly regulated my cats, I an unused to tailoring the dose to the bg with every shoot. I will also re-acquaint myself with the spreadsheet and try to get it going so others can see his history if I post. I appreciate your comments, thank you.
 
We advise testing before every shot always so good you will start. You don’t adjust based upon each shot. You don’t dose based upon the preshot either. You dose based upon how low a dose takes your cat. You test before dosing to be sure it’s safe to inject.
 
tiffmaxee said:
We advise testing before every shot always so good you will start. You don’t adjust based upon each shot. You don’t dose based upon the preshot either. You dose based upon how low a dose takes your cat. You test before dosing to be sure it’s safe to inject.
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Thanks for the clarification Elise. Simba was 341 ps this morning, having had the 1u last evening. I raised his morning dose to 2u, which he was stable on for many months prior to his heart disease. I have no intention, for the moment, of returning to his 3u dose he has been on for nearly a month. Last night's dose was intentionally conservative, in case he went low again. I guess it is good that he apparently had an episode of low blood sugar, but not hypo.

I am once again going to try playing hardball with my dry food lovers. I have Wysong Epigen 90 on hand, and (again) have ordered Young Living Zero (carbs) Mature Health formula and treats. The Epigen 90 is starch free also. They don't like either of them, at present. I really do think Simba's straying from his very high protein diet on the prescription dry food may be responsible for his lapse, as much or more, than his newly dx'd heart disease. Time will tell.

I will work on the spreadsheet as I have time this week. Thank you.
 
Today's 341 was probably also bounce on top of the reduced dose. Heart disease didn't make much difference to Neko's numbers, once she was on meds for it. Took her a couple days to get used to the new meds it seemed, than all back to normal. Is Simba on any meds for his condition?

A cat's insulin needs can change somewhat over time.

The other option is Dr. Elsey's chicken dry food, which is low carb.
 
Wendy&Neko said:
Today's 341 was probably also bounce on top of the reduced dose. Heart disease didn't make much difference to Neko's numbers, once she was on meds for it. Took her a couple days to get used to the new meds it seemed, than all back to normal. Is Simba on any meds for his condition?

A cat's insulin needs can change somewhat over time.

The other option is Dr. Elsey's chicken dry food, which is low carb.
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Thank you Wendy. Yes, Simba has AFib heart disease, and is on Pimobendan and Clopodogril for it. I do have some of the Dr. Elsey's dry food, but want to try and keep them away from any dry food that has any carbs at all. But, I already know they don't like the two that I mentioned earlier, and they don't like the Dr. Elsey's either. I guess we do the possible, and yes, I do know that their insulin needs can change over time.
 
Other options are Ziwipeak air dried food, or some of the freeze dried raw products. Not zero carb, but very low and OK to feed.

Neko was on pimobendan and clopidogrel as well. They didn't impact her BG's.
 
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