Low Glucose Warning - Up and Down every 15 Min

E

ETheCat

Member Since 2024
Hi everyone,

My cat E is about 11yrs old, tabby.

Previously had DKA and was hospitalized for 10 days in the ICU last year, got diagonosed with diabities but after a couple of months was deemed in remission

Last week, while checking something else we found out he looks to have diabities again, and has been on 0.5 (half unit) of Lantis 2x a day

He is wearing the Freestyle Libre 2, so I get live readings

He had a day all in good numbers, but other days all in high numbers, yesterday was all high

After tonights dose, his numbers went down from 20+ to under 4 within just a few hours

I was told to give honey and food, and he seems to keep bouncing between the low warning (went as low as 3.2/mmol) and then I give more honey (like 1cc) and some food (DM wet food) and his numbers go up close to 6 for a bit, but then back down

It's been going back and forth for over 2 hours now.

He has no signs of hypo, no drunk walking etc

ER is familiar with me, but with all of this it's been a crazy expensive year so they said it's upto me to either try keeping him in the green until the Lantis wears off, or bring him in for a constant glucose. But that if he goes under 3, bring him in right away

What do you think? It's late here, so I've woken him up a couple times now to give more honey because I ge the warning buzz my phone at 3.8/mmol

Should I keep waking him up to give honey and prompt food? Or is it time to bring him in to ER?
 
Bandit's Mom said:
What is the latest reading on the Libre and how long is it since he got insulin?
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Hi,

Insulin was almost exactly 5 hours ago.
0.5 (half unit) of Lantus Gargine
Given with both wet & dry DM food, ate all of it
Reading at that time was 19.3/mmol

First warning was 3 hours later, and went to 3.4

Last warning was 3.8, gave another bit of honey, went back up to 4 for a minute, but is now sitting at 3.4/mmol
 
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The normal range for blood sugar with human meters including the Libre, is 2.8-5.5 mmol/L, so at 3.8 he is within the normal range. Also, the Libre tends to read much lower in lower numbers. Will he let you test him using a regular meter - with a ear poke?

Btw, Purina Pro Plan DM canned is low carb but the DM Savory Selects and the dry are NOT. You need not restrict yourself to prescription food. Any low carb (with carbohydrates less than 10%) canned food will do. How much DM dry does he get?
 
The ER Vet said if he reads 3 or under he needs to come in right away. Isn't 3.3/mmol (where he is reading now) cutting that close?

The food I give is the prescribed food from the vet, it's Purina Pro Plan Veterinary Diets. 2 tbsp of each wet & dry

Is giving honey this many times bad?

I don't mind bringing him in if I have to, it's just been a very expensive year due to the very long ICU stay, and I was quoted tonight would be another $2-5K for the ER check and short stay monitored glucose stuff

I really hope the Insulin starts to wear off soon, but I know because it's long lasting, it's going to be another few hours.
 
You don't have to rush him to the vet if you are able to keep his numbers over 2.8 with food/honey. Will he not let you test him with a meter? The Libre might be giving you an artificial low?

It's okay to use honey to keep numbers up but it's possible that the dose is too high. We would need more data to help you with dosing. It's possible that he will need less insulin if you cut out the dry food.

A diabetic cat needs to eat a low carb canned or raw diet. The first thing many vets do is to ask you to feed a "prescription" food. There's nothing in prescription food that miraculously treats diabetes. Many of them are expensive, too high in carbs (especially the dry ones) and the ingredients tend to be of low quality. Most of our members in the US feed their own cats Fancy Feast Classics, Friskies Pates or 9-Lives Ground because they get less than 10% of their calories from carbs. They are also easy to find and affordable. You can find low carb variants in all brands of wet cat food.

What made the vet think he was out of remission?
 
Bandit's Mom said:
You don't have to rush him to the vet if you are able to keep his numbers over 2.8 with food/honey. Will he not let you test him with a meter? The Libre might be giving you an artificial low?

It's okay to use honey to keep numbers up but it's possible that the dose is too high. We would need more data to help you with dosing. It's possible that he will need less insulin if you cut out the dry food.

A diabetic cat needs to eat a low carb canned or raw diet. The first thing many vets do is to ask you to feed a "prescription" food. There's nothing in prescription food that miraculously treats diabetes. Many of them are expensive, too high in carbs (especially the dry ones) and the ingredients tend to be of low quality. Most of our members in the US feed their own cats Fancy Feast Classics, Friskies Pates or 9-Lives Ground because they get less than 10% of their calories from carbs. They are also easy to find and affordable. You can find low carb variants in all brands of wet cat food.

What made the vet think he was out of remission?
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Hi, no, he will not let me poke him. It becomes a huge stressful ordeal for both of us. But I can take him into my regular vet tomorrow for a spot check. They open in 4 hours, and can likely see me quickly.

In regards to out of remission, it's tricky and confusing.

We was reading high, 28/mmol for more then 24hrs, they gave him 1 dose of his numbers returned to normal and stayed there for a couple days. But then after another check his numbers went up and stayed up again.

Then we tested to only give Insulin if above 12, which for a couple of days ended up only being one dose

But then again the numbers ended up staying very high, so I was told on monday to give both doses no matter what. Although eexcept for once when it read 11, his numbers were always above that 12

Before this incident tonight, he was basically in the 20/mmol range for 2 days straight

When you say "it's possible that dose is too high" - you mean insulin right? And not honey.. I'm worried about giving too much honey tonight

For insulin, ER doc mentioned it's really not possible to give even less than the half unit since it's already such a mini amount
 
ETheCat said:
But I can take him into my regular vet tomorrow for a spot check. They open in 4 hours, and can likely see me quickly.
Click to expand...
You don't need to do that. Testing done at the vet's office is expensive and can be unreliable due to stress, which can significantly raise the BG. By testing at home, you get more accurate results.

He might also be higher tomorrow in reaction to the lower numbers he saw today. The highs following the lows are what we call "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).

What is his Libre reading now?
 
Bandit's Mom said:
You don't need to do that. Testing done at the vet's office is expensive and can be unreliable due to stress, which can significantly raise the BG. By testing at home, you get more accurate results.

He might also be higher tomorrow in reaction to the lower numbers he saw today. The highs following the lows are what we call "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).

What is his Libre reading now?
Click to expand...

The Vet spot check is quite cheap, they hook me up with it. it's also much less stressful for my cat, he sits just fine for them.

It was in the red about half an hour ago, I gave another 1cc of honey, he had a nibble of food, went up to green, was as high as 6 for a bit, but even as typing this, it's already down again, in the 5 min from typing, it's gone from 6.1 to 4.9 and is now 4.2/mmol

I'm worried about the constant honey because of the high sugar

And right now as I was about to hit send, alarm went off and Im in the red at 3.6/mmol
 
Numbers do tend to bob up and down with the Libre. Is it almost 6 hours from his shot time now?

You might want to speak to the vet about reducing his dose going forward.
 
Bandit's Mom said:
Numbers do tend to bob up and down with the Libre. Is it almost 6 hours from his shot time now?

You might want to speak to the vet about reducing his dose going forward.
Click to expand...

I was about to bring him in as it was 2.9, but not it;s going back up above 7.

So yes, about 6 hrs from last dose. ER doc was just on the phone, thinks maybe it could be starting to wear off and to just monitor at home

Can't really reduce dose, there isn't less then 0.5 measurable. But they are likely going to do an in-house curve at primary vet, as maybe he's in remission again. I suppose they may go back to only dosing if over 12-14, so once a day
 
ETheCat said:
So yes, about 6 hrs from last dose. ER doc was just on the phone, thinks maybe it could be starting to wear off and to just monitor at home
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Yes, he should start heading up soon. Go easy on the honey now and just food should be enough to keep him safe. The DM dry is anyway high carb.

ETheCat said:
Can't really reduce dose, there isn't less then 0.5 measurable.
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There is 0.25U below 0.5U. Do you use syringes to measure the dose? There are U-100 syringes that come with half unit markings and you can measure 0.25U with those syringes.


ETheCat said:
But they are likely going to do an in-house curve at primary vet, as maybe he's in remission again. I suppose they may go back to only dosing if over 12-14, so once a day
Click to expand...
Like I said earlier, the DM dry is high carb and can be contributing to higher numbers. You want to try cutting that out (but with close monitoring of his sugar). If the curve is run on a day when he is bouncing from previous lows, you would not get an accurate idea of what his BG is really like on a dose.
 
ETheCat said:
For insulin, ER doc mentioned it's really not possible to give even less than the half unit since it's already such a mini amount
Click to expand...
I remember taking my cat to an ER vet once and they asked what meds he was currently receiving and I said (whatever dose he was on of) Levemir and occasionally he got 0.1 unit of regular insulin. There was a vet and a technician in the room with us and they kept saying over and over you mean 1 unit right? And I kept telling them "No, 0.1 unit" at least five times. They eventually rolled their eyes at me and walked out of the room.
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Thanks everyone.

After my last post he ended up staying in the 6-8/mmol range consistently

Skipped the morning dose as the Dr suggested

His current reading has just recently gone up in the 10ish range

Next meal is in about 8hrs from now.

He didn't eat all of his morning food today, but likely because he ate during the low reading and was also probably tired

Vet told me not to give dose unless it goes over 14 at time when Insulin is due.

He has a checkup on Monday (currently it's early evening Saturday)

I do use the 1/2 unit u-100 syringes. So if I do need to give Insulin tonight, i will try for closer to .25
 
Sounds like he's in a good range now. Can you take the 911 off of the subject heading? Go to your first post of this thread, and using the Thread Tools drop down, you can edit the subject line to take off the prefix. The 911 always gets us worried, so good to take it down when the situation is resolved. Thank you.
 
Sure, thanks
Wendy&Neko said:
Sounds like he's in a good range now. Can you take the 911 off of the subject heading? Go to your first post of this thread, and using the Thread Tools drop down, you can edit the subject line to take off the prefix. The 911 always gets us worried, so good to take it down when the situation is resolved. Thank you.
Click to expand...
 
The following is a quote from catinfo.org
' there is absolutely no reason to spend your hard-earned money on veterinarian-prescribed diets.

Take a look at Dr Lisa's website, feline nutrition is her thing.

The dry 'prescription' diabetic food' is too high in carbs for a diabetic cat.

My cat George, is in remission, when he got into high carb food, his BG went from 60-70 (3-5 your numbers )range to 400 (23 your numbers) he stayed high for a couple of days (it cab take that llong for it to work out of their system, sometimes a little longer)

Here's the link to Dr Lisa's page,
https://catinfo.org/feline-diabetes/




Th
 
Just an update, and perhaps looking for more guidance.

My cat's levels went into a good range around 5am (about 5.5 hours after the insulin) and stayed in the good green level between 5-8mmol until 2/3pm

He had a meal at 11am, ate only about half of his food (but I also gave him alot of honey and food during the low crash between 2:30-4:30am

Between 4-8pm he crept up to 12, 14, 16, 20, and is now sitting at the HI reading since 10:30pm

It's now 11:20pm, usually his meal is at 11pm. He asked for food, but didn't eat it. And is now giving me the feed me stare, but again not looking to want to eat.

He seems quite bright, maybe a little sleepy today because of the long night. He isn't vomitting, not peeing excessibly (no signs of DKA)

Wondering if the lack of appetite today might be tied into the crash last night. Obviously I will be skipping this insulin dose if he does not eat.

Just wondering if anyone has insight

I have a vet appointment Monday, because they closed early today and are closed sundays, they couldnt fit me in today. Trying to avoid ER as it's been a very expenbsive year already and it will end up being at least another 3-5K because they said that regardless of the exam, due to his history, they would hospitalize him for a day just to monitor fully.

If he dosen't eat, should I take his food away at midnight (so that we can at least stay within an hour of the original dose schedule) and try to feed again at 11am ?
 
He’s literally Kelly bouncing.
  • 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).

  • would you be able to set up a spreadsheet? It’s much easier to see what’s going on. Have you been give. The directions? In the meantime since we are all in different places and time zones instead f telling us what time you do things use +followed by the number of hours after insulin. So +5.5 who’d be 5 1/2 hi yrs after insulin.
  • Sorry that nobody saw when you posted. Did you test again?
 
Hi.

He has a Freestyle Libre 2 on, so I have constant reading, he is still reading HI (usually means above 23) he has been in the HI range a few times this past week

He is acting mostly ok, maybe a little more quiet, but he's been like that most of the week since his hospital stay

At this point, his last Insulin was 0.5 half unit, 25 hours ago.

He had DKA last year, that is how we originally found out he had diabties at that time. This time around, it's been maybe 1.5 weeks since his last blood & urine test and there were no ketones.

I'm told that giving Insulin without food is incredibly dangerous.

He ate half of his afternoon meal 13 hours ago.

His next meal was supposed to be 1 hour ago, he has not ate.

It's Saturday here (technically Sunday 12:30am) my vet is closed until Monday. ER will be $3-5K and because he's acting normal they said to just monitor, otherwise it will be expensive as they will suggest a hospital stay for them to monitor. Besides not eating, and maybe a little less energy, showing no signs of DKA.

The bouncing was mentioned yesterday, and I really just don't understand. My regular vet retired, and I'm feeling very left out in the dark this time around, especially because it's the weekend, as the main Dr. who leads the case at the ER does not work weekends. Whoever the 24 hr ER doc who is on duty generally answers some questions for me, but at this point they are probably feeling like I'm calling way too much

I just have no idea what I'm supposed to be doing right now

**UPDATE 1** He went poo just now and was diarreah, could it be from the honey last night?

**UPDATE 2** He finally asked for, and ate his Wet Food, and I gave a little less than the 0.5 unit of insulin. Still acting mostly normal, hopefully no low glucose crash and we can get back on track

Thanks everyone
 
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