? Hypoglycemia found on labwork, but never during home testing

Amy and Owl

Amy and Owl

Member Since 2026
Hello, we've recently gotten Owl's most recent bloodwork back from his vet. Overall it is very positive, which is a huge relief. His elevated liver enzymes from the last test are significantly improved. This was our primary concern so it's very nice to see this issue resolving.

However, the vet noted that Owl was hypo at the time of his blood draw, at 55 mg/dL. I had not had the chance to test him at home that morning prior to his appointment. He got his insulin at 6:30am and we left for his appointment at 8:30am. He tested at 147 that morning two hours before his appointment.

I'm not doubting the bloodwork or the vet. I just don't know what to do going forward. She wants me to only give him insulin once per day in the morning and skip his evening dose.

My only guess is he's going lower later in the day than I typically test, because I am at work or asleep during those times. I will be home the next few days and will get more tests later in his cycle to see if I can catch him going low.

Where do I go from here? I feel awful thinking he's been going low and I didn't know. I have attached his bloodwork in case it is of use. I'd appreciate some input on how to dose him going forward.
 

Attachments

Looks like you cut the dose to 0.1 units? That was a good choice. One shot per day very seldom works. I've seen it work exactly twice in my time here, and people were on a drop dose only.
 
Wendy&Neko said:
Looks like you cut the dose to 0.1 units? That was a good choice. One shot per day very seldom works. I've seen it work exactly twice in my time here, and people were on a drop dose only.
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I didn't give him any insulin last night as the vet instructed but will be doing the .1 dose going forward twice a day. I'm so confused how he went hypo at the vet. If anything I'd expect him to be too high, not too low. And this is also after feeding him three meals that morning of about 8% carbs.

Since he is now on .1u should I stop mixing in the medium carb food and only feed him the 3%?

The vet suggested my Relion meter was inaccurate and that was why I missed him going too low. She wants me to use the alphatrak but the strips are so expensive.

I suppose it is possible that his first ever hypo just happened to be at the vet and we caught it on his bloodwork. But I'm so worried this has happened before or will happen again and I won't catch it on the Relion.
 
There's a difference between hypoglycemia and low numbers. We consider normal range on a human meter as 50 - 120. However, with Lantus, if you carefully read through the TR protocol, for a cat that is a year beyond diagnosis, reductions don't occur unless numbers fall below 50. From this perspective, Owl was in low numbers.

Hypoglycemia occurs when the cat has symptoms of hypoglycemia. These would include:
MILD HYPOGLYCEMIA
Sudden ravenous hunger
Shivering
Weak or lethargic

MODERATE HYPOGLYCEMIA
Disorientation
Trouble with vision... bumps into furniture
Poor coordination, such as staggering, walking in circles or acting drunk
Changes in head or neck movements
Restlessness
Urgent meowing
Behavioral changes, such as aggressiveness

SEVERE HYPOGLYCEMIA
Convulsions or seizures
Unconsciousness

My guess is that Owl was not symptomatic. It would be a concern is one of the vet's staff missed the symptoms and didn't intervene.
 
Sienne and Gabby (GA) said:
There's a difference between hypoglycemia and low numbers. We consider normal range on a human meter as 50 - 120. However, with Lantus, if you carefully read through the TR protocol, for a cat that is a year beyond diagnosis, reductions don't occur unless numbers fall below 50. From this perspective, Owl was in low numbers.

Hypoglycemia occurs when the cat has symptoms of hypoglycemia. These would include:
MILD HYPOGLYCEMIA
Sudden ravenous hunger
Shivering
Weak or lethargic

MODERATE HYPOGLYCEMIA
Disorientation
Trouble with vision... bumps into furniture
Poor coordination, such as staggering, walking in circles or acting drunk
Changes in head or neck movements
Restlessness
Urgent meowing
Behavioral changes, such as aggressiveness

SEVERE HYPOGLYCEMIA
Convulsions or seizures
Unconsciousness

My guess is that Owl was not symptomatic. It would be a concern is one of the vet's staff missed the symptoms and didn't intervene.
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No, he definitely was not symptomatic. He was acting entirely normal, even given that we were at the vet (he is usually very chill at the vet, and was during this appointment too.) The vet did a thorough physical exam and did not note anything unusual at the time either, which is why it was a bit of a shock to get his results back the next day to find he had been hypo at the time of the blood draw.

I am not sure what a 55mg/dL on their official lab machine translates to on a human meter (if any such thing is even possible.) When I tested Owl at home immediately following the appointment he was at 66 on my Relion meter. Low, but still normal.

The vet has me second guessing the Relion and myself and worrying I'm doing something wrong and failing to accurately test him.
 
If you were to compare the number of members here who have used a Relion meter since FDMB started to those using the AT, the Relion wins hands down. Add in those using human meters and the number is even larger. When I started, AT meters weren't a thing, even vets used human meters. Neko's vet at the time used the Onetouch (human meter) and said it was closed to what she'd get on the lab work.

FWIW, Neko's numbers often dove down at the vet. I'd always test just before we left for the vet, to compare to what I got on blood work.

8% food is still low carb, just on the higher end. On higher doses, his numbers really dove from +1 to +2, so I'd keep trying a little bit higher carb at +1 to see if you can slow down those dives.
 
Wendy&Neko said:
If you were to compare the number of members here who have used a Relion meter since FDMB started to those using the AT, the Relion wins hands down. Add in those using human meters and the number is even larger. When I started, AT meters weren't a thing, even vets used human meters. Neko's vet at the time used the Onetouch (human meter) and said it was closed to what she'd get on the lab work.

FWIW, Neko's numbers often dove down at the vet. I'd always test just before we left for the vet, to compare to what I got on blood work.

8% food is still low carb, just on the higher end. On higher doses, his numbers really dove from +1 to +2, so I'd keep trying a little bit higher carb at +1 to see if you can slow down those dives.
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I have a second meter at home that I may use to double check numbers. Maybe if I can show the vet that two different glucometers are showing similar numbers, she will be more open to trusting the Relion numbers.

Should I stay at .1unit for the time being and continue to test as I have been?
 
Wendy&Neko said:
Yes, let's see how a few cycles in a row at this dose goes. Unless he goes low again. Those early +2-+3 tests are good ones to get, they tell you if his numbers are going to dive.
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I will test more in the early numbers this weekend since I will be home. I usually do test in the +2 to +4 range because of this. Right now he is in the low 100s. Hopefully that comes down a bit with time. It is encouraging to have to reduce his dose this far so soon, but also nervewracking to think he can still go hypo on a miniscule amount of insulin.
 
Amy --

How are you feeding Owl? Gabby had an early nadir. As a result, I spread out her meals at shot time, +1, +2, and sometimes +3. This helped to prop up her numbers and generally prevent her from diving early in the cycle.
 
Sienne and Gabby (GA) said:
Amy --

How are you feeding Owl? Gabby had an early nadir. As a result, I spread out her meals at shot time, +1, +2, and sometimes +3. This helped to prop up her numbers and generally prevent her from diving early in the cycle.
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He gets 1/2 can of Fancy Feast (the 3oz can, I mix two types together 50/50 to make an 8% carb food) at shot time and then a quarter of a can of the mix at +1 and +2. Then half a can of 3% carb FF at noon. He still dives a bit in the first few hours after insulin, though as his preshot number comes down the dive is of course nowhere near as dramatic.
 
Amy and Owl said:
He gets 1/2 can of Fancy Feast (the 3oz can, I mix two types together 50/50 to make an 8% carb food) at shot time and then a quarter of a can of the mix at +1 and +2. Then half a can of 3% carb FF at noon. He still dives a bit in the first few hours after insulin, though as his preshot number comes down the dive is of course nowhere near as dramatic.
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On the SS if you scroll it to the left you’ll find remarks you can type his feeding schedule or any other data, we do read those notes when available😉 see Corky’s SS
 
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