09/21 - Low Numbers for the first time - advice

P

Pam and Tango

Member
Hi all,

Relatively new to treatment, we were dosing at 1.0 unit, but not seeing much change, vet recommended upping to 2.0 units, but I was nervous and stuck to 1.5. Today Tango's numbers are surprisingly low. I don't think we are heading to hypo yet, but curious your advice depending on what the rest of the day looks like.

Should I decrease the dose tonight to 1.25 units?

Thanks for the help!
 
Here is your previous post for continuity
https://felinediabetes.com/FDMB/threads/newly-diagnosed-dosing-advice.293498/

Since you are following the SLGS dosing method I would reduce the next shot to 1.25 units since Tango dropped under 90

From the SLGS sticky
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
 
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I would feed Tango some low carb food and keep testing ,
Can you please fill in at the top of your SS
The date diagnosed, the insulin, the method SLGS and the meter you are using , just so we don't have to keep going back to your signature for that information

I just noticed on your spreadsheet you are not testing Tango after his PMPS BG , we need you to get another test in before you go to bed. We are only seeing half the picture, can you do that ?:cat:
@Pam and Tango

When posting on the Lantus Board we post like this
Date Tango AMPS # and any other additional tests after that, you can continue with the PMPS numbers then. Try to post everyday and then link your previous days post to it, in case members need to go back and read it
Do you know how to link your previous post?
 
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Thank you!

Spreadsheet is updated, I use the world page and didn’t realize it hadn’t copied the information over to the US page.

I will decrease the dose to 1.25 tonight, and try to do a better job of some PM numbers.

At what value would you introduce higher carb food or gravy? I did get worried and let him have a small amount of dry kibble, retrospect I should have left him, he has bounced up now, but will continue to test throughout the day and see how we do.
 
Pam and Tango said:
Thank you!

Spreadsheet is updated, I use the world page and didn’t realize it hadn’t copied the information over to the US page.

I will decrease the dose to 1.25 tonight, and try to do a better job of some PM numbers.

At what value would you introduce higher carb food or gravy? I did get worried and let him have a small amount of dry kibble, retrospect I should have left him, he has bounced up now, but will continue to test throughout the day and see how we do.
Click to expand...
Hi Pam , it's been so long since I had to give insulin like 3 and a half years but let me tag a few members to answer your question about when to feed higher carbs .
Question does he normally have kibble also besides the low carb wet food?
@Pam and Tango

One other thing
When posting on the Lantus Board we post like this
Date Tango AMPS # and any other additional tests after that, you can continue with the PMPS numbers then. Try to post everyday and then link your previous days post to it, in case members need to go back and read it

Do you know how to link your previous days post to your new one ?

What of food do you feed

Instead of kibble you can if he drops to low
Med and High Carb food and have honey in your house



Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods



https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.

16- 24 is high carb.


I did a search on our site and found this posted by one of our members
She said

Here's my handy dandy cheat sheet for feeding the curve and testing during low numbers:
60 or higher: LC (0-10% carb) + test in an hour
50-59 : MC (11-15% carb) + test every 30 minutes
49 or below: HC (>16% carb) + test every 15-20 minutes and then for two hours after the lowest number appeared until they start going up"

But let's see what the members I tagged has to say when they look at your spreadsheet

@Pam and Tango
 
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Pam and Tango said:
Thank you!

Spreadsheet is updated, I use the world page and didn’t realize it hadn’t copied the information over to the US page.

I will decrease the dose to 1.25 tonight, and try to do a better job of some PM numbers.

At what value would you introduce higher carb food or gravy? I did get worried and let him have a small amount of dry kibble, retrospect I should have left him, he has bounced up now, but will continue to test throughout the day and see how we do.
Click to expand...
@Sienne and Gabby (GA)
@Wendy&Neko
@Bron and Sheba (GA)
@Bandit's Mom
@Suzanne & Darcy
@Angela & Cleo
 
Pam -
You shouldn't have to manually fill in the numbers on the US page if you logging Tango's numbers on the World template. The numbers should appear automatically. I'm tagging @Bandit's Mom to see if she can figure out where the glitch is.

Since you're following SLGS, you do want to decrease the dose to 1.25u.

I have some additional suggestions. With Lantus, the minimum number of tests you want to do your best to get is 4 -- your two pre-shot tests (AMPS, PMPS) and at least one additional test during both the AM and PM cycles. Lantus dosing is based on how low the insulin takes your cat's numbers -- it's not based on the pre-shot test data. Further, without PM tests, you're missing half of your data. You have no way to know if Tango has needed dose reductions that you've missed during the PM cycle or at other points during the AM cycle. While you'e been getting weekly curves, the curve doesn't help to inform you whether Tango has needed his dose adjusted. Also, with SLGS, dose changes are made in 0.25u increments.
 
@Sienne and Gabby (GA)
Hi Sienne the BG tests were automatically appearing in her US tab
I had asked her to
Can you please fill in at the top of your SS
The date diagnosed, the insulin, the method SLGS and the meter you are using , just so we don't have tokeep going back to your signature for that information, not the tests :cat:
Also can you please tell her because she asked
above


At what value would you introduce higher carb food or gravy? I did get worried and let him have a small amount of dry kibble, retrospect I should have left him, he has bounced up now, but will continue to test throughout the day and see how we do.

Thanks Sienne
 
Sienne and Gabby (GA) said:
@Diane Tyler's Mom GA - unless Pam just added the info on Tango's spreadsheet, it's there. It's not in the colored blocks, though, It's in the cells next to the colored blocks. Maybe I misunderstood, but Pam said,
Click to expand...
I'm confused lol , I was talking about on her US tab that she didn't fill in up top when Tango was diagnosed, the insulin , the dosing method and the meter she's using. Then she did fill it in when I asked her to.
Do you have any advice to tell her about what she asked about

At what value would you introduce higher carb food or gravy? I did get worried and let him have a small amount of dry kibble, retrospect I should have left him, he has bounced up now, but will continue to test throughout the day and see how we do.

@Sienne and Gabby (GA)
Thanks Sienne :cat:
 
Many times you do not need to use high carb food at all and a small amount of low carb food (up to 10 percent) is enough to stabilize the BG. You can give an LC wet food spoonful when in the 50s or nearing the 50s and test in about 15-20 minutes to see if the numbers are stable or rising. If you are uncomfortable with that at first, try a little medium carb wet food when in the 50s and test in 15-20 minutes to see if numbers are stable or rising. A lot of the decision-making on this stuff depends upon how well you know your cat’s response to carbs. In the beginning, you will gather data on how your cat responds to carbs of differing levels. I have no problem with the guidelines that Diane provided for the beginning of your FD journey. As you learn how your kitty responds to carbs you can tailor it to Tango’s needs. If LC doesn’t stabilize the BG, then you can move to MC. If numbers drop below 50 then you can give some gravy from a high carb food like the Fancy Feast Gravy Lovers foods. Always try to use small amounts to make sure you don’t fill up the cat - because you may need to keep feeding to manage the numbers.
One thing to consider when looking at the numbers is — what time in the cycle are you seeing the low numbers. If it’s quite early in the cycle and hours before nadir, you may wish to be a little more aggressive with the carbs. Does this make sense? As you learn your cat’s patterns, you will know if he tends to dive down or tends to stabilize. It’s really helpful to is and also to you if you will note what you fed (carb percentage) and when — so you can document Tango’s response to carbs. You can put this on your spreadsheet in the notes section.
 
So let’s look at today’s cycle. What did you feed when you saw the 56 at +2 and when you saw the 59 at +4?

OBTW, if you get a number below 50 go ahead and give a little bit of karo to raise the BG. This can be given in an oral syringe mixed with a little water a d applied to the gums (makes it a little easier to administer) or rubbed directly on the gums. Have you read the information about how to handle a hypo? It is a good idea to have it printed out and put somewhere like your refrigerator in the beginning.
 
Thank you all so much for the help and support, it has been a day of learning for sure!

To answer the questions, regarding the spreadsheet, I believe the issue was in the header with the insulin and dosing information not copying between pages. I added it to the US page, so that should show ok now. The values themselves were copying over from page to page, with some missing colours. I have reached out in the tech support group to see if that glitch can be fixed, as when I check on my phone all is coloured and appears normal.

When I noticed his numbers at 56 and 59, I gave him a small amount of his old kibble (Hills Prescription T/D). He otherwise only gets FF pate. I realize now I should have stuck with the FF and supported the values rather than causing what resulted in a large spike, which he is still hanging onto. I will take another reading shortly and try to get a few more PM values to help with realizing how the insulin is affecting him. I won't panic again unless we are below 50!

We will continue to take things slow, tonight I gave him 1.25 units, so will see how he does with that dose for the next few days. I do have a hypo kit at home, with med carb FF (gravy), the list provided in this thread was super helpful!
 
Just seconding that you are doing great! I was in your shoes a couple months ago and the amount of information you have to process in a stressful situation is… a lot. The folks giving you help in this thread are all wonderful. Keep asking questions when you are unsure, you’ll get great support here.
 
I agree with Suzanne. For many cats, it takes longer for them to metabolize dry food so the numbers aren't quite as responsive compared to using a higher carb canned food. My kitty had stomach issues with gluten which is often an ingredient of the gravy/high carb foods. The alternative is to use a drop or more of some kind of high carb syrup (e.g., corn syrup, honey). Syrup works very quickly but you need to be careful to not be overly generous with the amount unless numbers are dangerously low.l
 
Sienne and Gabby (GA) said:
I agree with Suzanne. For many cats, it takes longer for them to metabolize dry food so the numbers aren't quite as responsive compared to using a higher carb canned food. My kitty had stomach issues with gluten which is often an ingredient of the gravy/high carb foods. The alternative is to use a drop or more of some kind of high carb syrup (e.g., corn syrup, honey). Syrup works very quickly but you need to be careful to not be overly generous with the amount unless numbers are dangerously low.l
Click to expand...
You say not to be overly generous with the syrup. I took am having problems with low numbers and have honey on hand. How much honey should you give? I can't seem to get it on my kitty's gums, but she will lick it or eat with food. I just didn't know how much to give
 
It's fine to add it to food or let your cat lick the honey. There's not a precise way to know the amount. Try (literally) a drop or two. Re-test in 15 - 20 min and see if there's a response. If numbers are still low, try another drop or two.
 
Thanks. She gave a 3.4 mmol/L reading just before she should have had her shot tonight. Hence I dare not give her the shot. We are waiting on some results back from the vet. My kitty seems to have low readings at night and high in a morning.
 
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