1/13 McKenna - Low BG

[Dallas]

Tuesday evening, we started splitting McKenna's insulin dose. She received 1 unit that night and 1 the next morning. Wednesday morning, I realized I only had a few test strips left, so I haven't been able to monitor her like was probably necessary. I ordered some more but they wouldn't come until today (Friday). I called and visited several stores trying to find some. I called my vet to see if they had any. No luck. I've watched her behavior closely and she has seemed completely normal.
This afternoon, however, things changed. She came to the living room around 2:30, where my husband and I were eating lunch, wanting food. She seemed restless, kind of pacing. At 2:50, my daughter found her in the kitchen eating some ham that was leftover from my baby's lunch, which I'd forgotten to put away.
I tested her BG - it was at 88. I immediately gave her a can of food and checked again at 3:20. It had gone up to 111.
I'm going to watch her and check her numbers frequently for the rest of the afternoon. I assume I need to reduce her dose, but I'm not sure really how to proceed. She didn't eat a good breakfast, so could that have played a part?
I'm relieved her numbers came back up, but I'm nervous.

 

[Wendy&Neko]

Any chance you can go to a nearby pharmacy and get a backup meter to use until the AT strips come in. Any human meter will do. If you have a Walmart nearby, the Relion Confirm or Micro use a small drop of blood and have much cheaper strip prices.

88 on the AT is an OK number. We get worried if they go below 68. Giving her some low carb food, a couple tsps was a good idea.

Are you following Tight Regulation or Start Low Go Slow? They have different reduction points. It'll help us help you if you put TR or SLGS in your signature.

 

[Chris & China (GA)]

I called my vet to see if they had any. No luck

That's another big reason why most of us use human meters....it's not only a lot cheaper, but getting strips is a lot easier too!!

88 is still a safe number but without the AMPS, it's hard to say how quickly she dropped.....a fast drop can also make them act like they're really hungry, not just a "low" number

Not eating enough could contribute to a lower than usual number too, but with Lantus, it's not as important that they eat a certain amount before the shot....just that they're willing to eat. It doesn't usually start to "kick in" for 2-3 hours after it's given

On reducing the dose, it depends on which dosing method you're using. On Tight Regulation, we don't reduce until they drop below 68 on the AlphaTrak, but on Start Low, Go Slow, we reduce when they drop below 90

We need you to decide which method you want to use....you can always switch later if you decide to though!!

 

[Dallas]

The strips came in just before all of this happened. So I've been able to test her and will continue to do so through the afternoon. I think I will just start keeping a backup box. Learning curve, I guess.
So far, I've been following my vet's advice on dosing, but I've had a hard time getting in contact with him this week. I'm not sure which method is better. Given the extremely high numbers she has had, and the history of Ketoacidosis, I am wondering if Tight Protocol would be better for her. To get her regulated faster?
She is up to 146 now.

 

[Dallas]

Ok, after reviewing the protocols more, I think we're going to do Start Low, Go Slow. It seems to fit with what my vet has been recommending we do and how we've handled the insulin so far. Given that, I would reduce her insulin by .25u, correct?

 

[Doodles & Karen]

Given that, I would reduce her insulin by .25u, correct

That's correct so her new dose is .75 and you would hold the dose for 7 days unless she goes under 90 again. Keep in mind the 1u dose can influence up to 6 cycles because of the depot. Just mentioning it because testing is still needed. Good catch today and congrats on the reduction

 

[Chris & China (GA)]

Some of the very basic differences are:

TR...dose adjustments can be made as often as every 3 days (6 cycles)...this is most effective because if they're staying in numbers we don't like, we can increase more often
SLGS...dose adjustments are made once a week....this can be hard on the caretaker IF the cat is "stuck" in high numbers very long

TR...reductions in dose are given if they drop below 50 on a human meter, 68 on a pet meter
SLGS...reductions are given if they drop below 90 on either meter

TR...You'll want to get the 2 PS tests and at least one other test....preferably at least 2 other tests.....One somewhere between +4 and +7 on the AM cycle and a "before bed" test on the PM cycle...if you can only get 1, the "before bed" test is most important since most cats go lower at night
SLGS...You still must get the 2 PS tests in, and then do a curve once a week (testing every 2 hours for 12 hours or every 3 hours for 18 hours)

 

[Wendy&Neko]

To answer your question, yes, tight regulation would get her regulated faster. But we still see cats get regulated on the SLGS. After several attempts at not being able to get in touch with my vet on a timely manner for dosing advice, I decided to just switch to getting advice here and following the guidelines here (TR in my case). I still dropped the spreadsheets off every week so she could keep seeing the progress, for a while at least. Until I felt comfortable going on my own.

A backup meter is always hand in case you run out of strips or something happens to the other meter. There are several funny stories of cat tails swishing meters in fountains, meters getting microwaved instead of the rice sock.

 

[Sienne and Gabby (GA)]

Are you still feeding the Royal Canin? (It's in your signature block.) If so, it's probably too high in carbs for you to follow TR. TR requires that a cat is on a diet of low carb, canned food.

 

[Dallas]

Are you still feeding the Royal Canin? (It's in your signature block.) If so, it's probably too high in carbs for you to follow TR. TR requires that a cat is on a diet of low carb, canned food.

That has been one of the frustrations this week. I was feeding her that and she seemed to be doing well. I only had a few cans left, so when one of our other cats saw the vet last Friday, I asked where I should get some more, since they had given us that to get us going when McKenna was first diagnosed. He said he'd pick some up over the weekend and bring it by (he's a mobile vet). Long story short, on Monday he was out and his assistant said it hadn't come in yet, so she said she would pick some up, but she ended up bringing Hill's M/D. So we've been on that all week. They finally dropped off the Royal Canin today. I think I'm going to switch her to Fancy Feast because I don't want to have to be in the situation of depending on the vet again. I realize he's super busy, but all of the food changes are not going to help.
Also, how do you know how many carbs are in the food? They aren't listed on the can and the Royal Canin Diabetic isn't on Dr Lisa's Food Chart that someone linked to me.

A backup meter is always hand in case you run out of strips or something happens to the other meter.

I actually have a human meter from when I was pregnant and had Gestational Diabetes. Wish I had thought to use it or realized I could.

 

[Doodles & Karen]

If you change her food to FF, there's a good chance her insulin needs are going to come down fairly quickly. So I would do it gradually and test often.

 

[Sienne and Gabby (GA)]

This is a link to a carbohydrate calculator that will give you an approximate value if you are using guaranteed analysis information. The only way to have accurate nutritional information is if you have "as fed" values which you may need to request from the manufacturer. If you are feeding the Royal Canin glycobalance canned food, the carb count is around 4.5%. If you're feeding the dry version, it's over 29% -- although, it sounds like you're feeding the canned version. While the carbs are OK, my biggest concern with the prescription foods is that the ingredients aren't the best. The list of ingredients in the Royal Canin canned are:

pork by-products, chicken liver, chicken, wheat gluten, powdered cellulose, gelatin, wheat flour, modified corn starch, natural flavors, calcium sulfate, guar gum, calcium carbonate, fish oil, potassium chloride, taurine, sodium silico aluminate, potassium phosphate, carrageenan, vitamins [DL-alpha tocopherol acetate (source of vitamin E), L-ascorbyl-2-polyphosphate (source of vitamin C), thiamine mononitrate (vitamin B1), niacin supplement, biotin, D-calcium pantothenate, riboflavin supplement, pyridoxine hydrochloride (vitamin B6), vitamin B12 supplement, folic acid, vitamin D3 supplement], L-carnitine, marigold extract (Tagetes erecta L.), trace minerals (zinc proteinate, zinc oxide, ferrous sulfate, copper sulfate, manganous oxide, sodium selenite, calcium iodate).

Pork isn't particularly great for cats and these are by-products as the first ingredient (vs muscle meat). Cat's don't need that much liver. Some cats have gluten sensitivities. Celulose is wood fiber. You really don't want to give a diabetic cat wheat flour or corn starch, gums aren't great for anyone, etc. In addition, for what you're spending on a prescription food, you would spend less on a high quality, human grade cat food (e.g., Wellness, Weruva). I buy my canned cat food on-line from Chewy's and have it on autodelivery. It ends up costing much less than if I were purchasing at a store. If I run out, though, I can always find it at a local pet food store.