Rapidly dropping BG

Okay, I will definitely continue to monitor him. I had to run out briefly to pick my car up from the shop, but he was 115 and holding steady and I will be home again in 10 minutes.
 
If you could please put some of the numbers during the past few hours into the spreadsheet it would be helpful. You can put in a few of them in around 15 minute increments between the +2, +3, +4 hours? I know it’s a pain. It’s helpful to see the progression. And also if you could please note (in the remarks or even in the cells - people do it different ways) what you fed him and when in the cycle it was fed.

edit: I see you have put in some of the readings thanks. This helps.
 
Just wanted to update you that Cash's BG has been steadily climbing and is at 202 currently and he will be eating lunch very soon! Sorry for the delay, I had a meeting!
 
I'm about to update my spreadsheet, but Cash has been steadily climbing back up and is at about 335 now/at 4pm. He normally eats dinner/gets his second shot around 5:30-545pm. My vet recommended to give 2 units (instead of 2.5) for peace of mind and then start 2.5 again in the morning. Do you have any thoughts?
 
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Chellie said:
I'm about to update my spreadsheet, but Cash has been steadily climbing back up and is at about 335 now/at 4pm. He normally eats dinner/gets his second shot around 5:30-545pm. My vet recommended to give 2 units (instead of 2.5) for peace of mind and then start 2.5 again in the morning. Do you have any thoughts?
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2.5 units is clearly too much insulin for Cash. I would recommend cutting the dose to 2 units also and NOT increasing back up to 2.5 tomorrow. If you do that, he may have the exact same result as today — unless he’s bouncing, but still… as soon as he starts to clear the bounce he will drop too low on the 2.5 dose. When we do reductions here, the reduced dose is the new dose going forward. If his numbers show us that he needs more insulin then we increase after holding the dose for enough time to assess how low the dose is taking the cat
 
Normally, reductions are .25 units. In Cash’s case today, the reason I suggest a .5 unit reduction is because he clearly would have dropped lower than we want him to and it took a lot of HC food to bring his numbers up. I am actually concerned that a .5 unit reduction will not be enough, but if you can monitor him tonight long enough to make sure he’s in the clear then I am fine with reducing to 2 units.
 
That makes sense to me. I think I will dose him at 2 units tonight and hold that dose until we are done with transitioning him completely. My partner also feeds him and this LC/HC ratio is not very scientific and consistent. I will keep him at 2 while we transition him to 100% low carb and then assess.
 
Okay, I understand. Yes, I will be here all night and can monitor him. I think with how high his BG is now pre shot, at 375, 2 will be okay. We will definitely know more about how his body is responding to the insulin after another shot. Also, I normally only give his shots 11 hours apart. Tonight, it will be closer to 12 actually. Do you think I need to make sure its exactly 12 apart moving forward?
 
Oh, and don’t be surprised also if he bounces from the lower numbers today. His body isn’t used to them yet and we don’t know if he’s going to be bouncy yet because he’s never even had blue on his spreadsheet before.
 
Chellie said:
Okay, I understand. Yes, I will be here all night and can monitor him. I think with how high his BG is now pre shot, at 375, 2 will be okay. We will definitely know more about how his body is responding to the insulin after another shot. Also, I normally only give his shots 11 hours apart. Tonight, it will be closer to 12 actually. Do you think I need to make sure its exactly 12 apart moving forward?
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11 hours could make it tricky for you to shoot when he’s in lower numbers. I think we will just have to see how it goes.
 
Oh I see, good point (about the bouncing). I guess that's why it's important to hold the new dose for longer, to see exactly what's going on.
 
I will say that Cash did not start getting better clinically until we upped his dose to 2.5. He finally stopped drinking too much water, muscle weakness stopped, and is acting like himself again. You don't think moving down to 2 will undo all of that progress do you? Is it possible that the insulin just finally got through to him?
 
Chellie said:
Oh I see, good point (about the bouncing). I guess that's why it's important to hold the new dose for longer, to see exactly what's going on.
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That is one of the reasons, yes. If the cat’s BG appears to be stuck in high numbers (due to a bounce,) it may appear that more insulin is needed and if you go ahead with an increase in insulin and the cat starts to clear the bounce after that, you can get a double whammy of increased insulin and the bounce clearing at the same time.
 
Chellie said:
Is it possible that the insulin just finally got through to him?
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If it were a “breakthrough dose” we would expect to see better numbers but you would not need to use a whole bunch of HC food to keep him from dropping so much.
Don’t worry, we will get him regulated and feeling better. We have to get there safely.
 
Thank you, that makes sense! So far Cash is staying on the high end tonight (360s), so I'm not worried about hypo currently. Will know more in about an hour though. Hopefully he will still drop some into the yellow overnight.
 
Just checking in about Cash. While his numbers overnight were pretty high and he got above 400 again preshot for the first time in 4 or 5 days, I was pleasantly surprised that his daytime hours weren't too, too high though. However, we had a bit of a weird dinner/PM shot that I wanted to talk to you about. Cash's numbers were steadily increasing all day per normal after nadir, but oddly started to drop a little before dinnertime. He also threw up a tiny amount (I might have made a mistake to buy him cat grass at the farmer's market and he ate a lot). It was just a little spittle and grass, and I figured it might be because he was hungry as well (as I had waited to more of the 12 hour mark instead of 11 today). His preshot numbers were a little lower than I'm used to with him, and him dropping a little bit beforehand, plus the tiny amount of vomit was worrying me. So, I waited until around 40-45 minutes after he ate to give him insulin (he was grazing on the wet food throughout these 45 minutes though) just to make sure he wasn't going to throw up again. I gave him a slightly lower dose as well, 1.75. His numbers seem to basically be the same from preshot to 45 minutes later which was also a bit odd to me...I am used to them climbing a bit. So now I'm starting to question how I handled it and am worried perhaps I should have done an even lower dose or skipped, but I was trying not to overreact. If you have any thoughts on the matter, I would appreciate it. Thanks so much!
 
I don’t think you necessarily did anything “wrong” except that with his preshot hovering around 300, I would have definitely shot the full two units. We gave him an extra large reduction that he really did not “earn” by dropping below 90, but not without good reason after he had to have a lot of HC to keep his BG up. So 2 units is already a pretty reduced dose.
 
As for the numbers, I am not concerned about the 307/300 to 311 at +1 because, with meter “variance” that is considered to be flat/stable and really would have to be a lot higher to be considered rising BG.
 
Okay, it sounds like I was perhaps overacting a bit. Thank you. I think I'm paranoid about him dropping again and his PMPS was much lower than it ever is at dinner, which was probably actually a good thing! The vomiting threw me off too. So I should probably just go back up to 2 in the morning right unless something else crazy happens?
 
Sometimes I think the Libre can be both a blessing and a curse, since it is easy to watch all these small fluctuations and put too much stock in them.
 
Chellie said:
Sometimes I think the Libre can be both a blessing and a curse, since it is easy to watch all these small fluctuations and put too much stock in them.
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The Libres are very convenient. It’s just a good thing to be able to check with a handheld meter when the low BG alarm goes off. It’s easy to become obsessed with the constant stream of data, too. I have found myself waiting and waiting for the numbers when I am helping a member who’s using a Libre.
 
If Cash has a typical preshot tomorrow morning or doesn’t drop below 90 tonight then yes, give 2 units tomorrow morning. If he has a blue preshot then we might have to consider a reduced shot simply because we haven’t seen one of those before.
 
I think I’m a bit confused on what to do if it isn’t a typical preshot morning though. I know that people don’t generally shoot if it’s below 200. But what if it’s 220, 230, or 250, which is not typical for Cash? I think 280 is the lowest AMPS he’s had. It’s a bit of what took me aback this evening as seeing 298/300 for pre-dinner was not typical!
 
Cash has gone safely into the blue today, just barely. But had a slow curve down since his AM shot. It's possible he'll keep trending down a bit more, but we'll see what happens after his "lunch." Feeling optimistic about 2 units. As I posted earlier, I am a bit unsure of what to do if he doesn't come up to normal preshot numbers for dinner though. Not sure what to do with a PMPS in the mid to low 200s.
 
I think if he is 200 or above you should shoot 2 units. Remember he just had a big reduction of half a unit.

Is he 100 percent low carb now?
 
He is not at 100%, I would calculate his food to be about 14% carb. 1.5 cans 8% lower carb wet food and 3/8 can HC 40% a day. He will definitely be above 200 at shot time, he is around 250-260 now already. Thank you again for your helpful advice!!
 
Chellie said:
. I know that people don’t generally shoot if it’s below 200.
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This guideline of not shooting below 200 is, of course, just for beginners. Gradually as data is accumulated on the spreadsheet, the caregivers learn to shoot lower and lower numbers (that’s the goal anyway.) It just takes time and data and trial and error sometimes.
 
Hi! Just checking in. I just got home from work and Cash is hovering between 199-206 and looks like he has been in the low 200s since 3:30 or so. He normally has dinner in around 20 minutes (530 pm CST). I'm feeling pretty nervous to give him his 2 units as this is the lowest he's ever pre-shot by 50-60 points. Any thoughts? Thanks!

I will add that during his smaller "snack meals" (lunch and bedtime) if his numbers are on the high end, I have been eliminating the HC from the wet food mix, which I did at lunch today. I always give the HC/LC mix with the shot, but sometimes eliminate it in between shots for those meals so as to not spike his BG and to slowly wean him off. This could have contributed to him going lower this afternoon.
 
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He is also a little under the weather, I believe it's a herpes flare up. Not sure if that could affect numbers or insulin reaction.
 
Can you stall his dinner by 30 minutes and see if he is rising or stable? Maybe feed at 5:45 and test before he eats? That’s only 15 minutes late. You can still shoot on time tomorrow.
 
He seems like he could eat, not overly hungry. As I mentioned, I believe he's dealing with a herpes flare up so is a little more lethargic this week. I can stall his dinner. If he is staying between 199-low 200s, should I proceed with the shot? And if its trending down skip it completely or maybe just lower the dosage?
 
My honest opinion is that he should get the full 2 units if he’s at or around 200. This morning he was at 262 and got 2 units and he did fine and stayed mostly in yellow. I don’t think 2 units is going to drop his BG too low and it’s a very good opportunity to see how he would do on 2 units with a PMPS of ~200. You have the Libre to alert you to any low BG. You can easily get an early handle on the cycle if he looks to be dropping a lot by +2.
 
Chellie said:
I will add that during his smaller "snack meals" (lunch and bedtime) if his numbers are on the high end, I have been eliminating the HC from the wet food mix, which I did at lunch today. I always give the HC/LC mix with the shot, but sometimes eliminate it in between shots for those meals so as to not spike his BG and to slowly wean him off. This could have contributed to him going lower this afternoon.
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This is a good thing! I am glad you are doing this. It takes about 2 hours for the effect of the high carb food to wear off so this will hopefully allow him to drop somewhat by mid-cycle. Today he was pretty flat and only has been gradually dropping down toward PMPS (probably from lack of food.)
 
I agree, I think it is a good opportunity to see how he reacts on 2 units when he is around 200. I will feel slightly better if he increases a little bit in the next 15 or so minutes though I will admit.
 
I would like to make sure he will eat. It doesn’t have to be a lot of food all at one time, but just so he eats and will be willing to eat a little more in the first two hours after his shot.
 
I feel pretty confident he will eat and wont' give his shot until I can see his appetite is normal. Which is what I usually do. Also, he loves that HC wet food so if we need to bring him up, that's a good option.
 
It was holding at around 199-200 while I was preparing his dinner, and as soon as I set it down his numbers went from 197-195-188 and now I am feeling much less confident in giving the 2 units...
 
Its back up to 191, but it did go down by 10 points (from where it was at 200 for so long) and is hovering there.
 
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