1/24 Xander - AMPS 230, +1 155, +2 99, +3 66, +4 146, +5 108 - Not TOO low, but help wanted please!

[Brianna & Xander]

Post from a few days ago

Hey guys,

So Xander had his first low (or at least, the lowest we've had so far). He started seeming a little more lethargic/sleepy than usual once got below maybe 90 or so. I kept watching, but once he dropped below 80 (which my vet didn't want to see) I gave him some of his dry food with a Friskies Lil Gravies poured over it to entice him to eat. I think he mostly licked up the gravy, not sure he ate much if any of the actual kibble. We didn't have any of the HC wet food (was literally planning to buy some today but hadn't gotten there yet) so my partner ran to get some.

The lowest number I saw on the Liibre was 54 at 11:47 AM (+3.25). I wanted to double check the number so I had to try manual for the first time. I was an idiot and hadn't set up the meter beforehand, so that took some time, getting blood took some time, and then I kept getting a "used strip" error. When I finally got it all to work he was at 75 on the Contour Next ONE and 65 on the Libre.

By about 12:15 PM he was up just over 100 again. Got to 141 at 12:30 but has started to go back down again, so around 1:30 I gave him about a teaspoon (0.6 oz) of the Fancy Feast Gravy Lovers food, which he ate all of. He's sitting at 105 right now.

Last night when I gave him his 2 units it was just BARELY over because the rubber stoppers are a bit of a pain and I just couldn't get it where I needed it. Literally so slight you'd really have to look to see it. I would wonder if maybe this is why he went so low, but when I gave him even more than that (0.5 u) the other day as a reduced dose, it literally seemed to have no effect at all.

His AMPS was just slightly higher than the one I had on the 20th when I skipped his morning dose, which later that day seemed like it would have been fine to shoot. But this time he did go very low, so it seems like I was right to have skipped it.

My last post was asking how I can know if it's safe to shoot when his nadir shows up after the time for next injection, and since then I've been trying to really see how he reacts to insulin. On Wednesday night, he was going over and under 150 so I took the FAQ advice to give a token dose and gave him 25% (0.5 u). I saw afterward that that didn't have much effect at all, and felt slightly more confident about what to do next time.

But now with him going this low even when he was over 200 all that confidence is lost. I have no idea what to do. What should I do about his dose now?

I also emailed the vet, but am not sure when I might hear back.

 

[tiffmaxee]

You are not following one of our methods but you write closer to SLGS. so since there was a reading under 90 a reduction should be taken and the new dose would be 1.75. If 200* at PMPS you can shoot a full 1.75. If under that post asking for dosing advice. Do you have a meter? Can you get an ear prick to test? The Libre sometimes reads artificially low which is why I ask.

 

[Brianna & Xander]

You are not following one of our methods but you write closer to SLGS. so since there was a reading under 90 a reduction should be taken and the new dose would be 1.75. If 200* at PMPS you can shoot a full 1.75. If under that post asking for dosing advice. Do you have a meter? Can you get an ear prick to test? The Libre sometimes reads artificially low which is why I ask.

I only say "closer to SLGS" because technically my dosage is based on what the vet told me, but I am using advice from the stickies about what to do so far. My vet's advice originally was essentially "2 units unless he doesn't eat much, then 1 unit." She wasn't going to have us testing either, but I've been doing that and have reduced doses based on the FAQ. I just don't have enough data yet to know how he reacts to different dosages but have been trying to find out (for example by giving a half unit a couple of nights ago when he was <150.)

I'm just surprised by how low he's gotten when his AMPS was over 200, so I guess I don't know if reducing to 1.75 is enough of a reduction, or if maybe people think the guidance about shooting low numbers isn't good for my boy, etc.

I did an ear prick to double check. At the time I got 65 on the Libre and 75 on the Contour meter.

 

[Angela & Cleo]

I agree with what Elise said here:

but you write closer to SLGS. so since there was a reading under 90 a reduction should be taken and the new dose would be 1.75.

A lot can happen between now (AM+6) and PMPS and since Xander saw his lowest BG since starting insulin, he may just bounce tonight. A bounce is defined as:

• 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).

 

[tiffmaxee]

Look at the dosing sticky and you will see a typical active cycle. It will go down and then head back up but the next shot. The depot from the larger dose will effect the next 4-6 cycles, sometimes more, sometimes fewer cycles. I strongly suggest you get some mc and hc wet food to guide his cycles as it works to bring up the bg in 20-30 minutes. You can also add honey to his wet food until you get mc and hc. It works fast but goes away fast so you might need to add some every 20 minutes and keep checking his bg. That’s easy with the Libre.

 

[Brianna & Xander]

I agree with what Elise said here:


A lot can happen between now (AM+6) and PMPS and since Xander saw his lowest BG since starting insulin, he may just bounce tonight. A bounce is defined as:

• 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).

I've seen him bounce before (or at least that's what his SS was analyzed to have done in the last thread) so I understand his numbers will go up a bit, but should I still reduce to 1.75 or should I go lower, to maybe 1.5? I ask because he didn't just go below 90, he went all the way down to the 50s-60s.

 

[Brianna & Xander]

Look at the dosing sticky and you will see a typical active cycle. It will go down and then head back up but the next shot. The depot from the larger dose will effect the next 4-6 cycles, sometimes more, sometimes fewer cycles. I strongly suggest you get some mc and hc wet food to guide his cycles as it works to bring up the bg in 20-30 minutes. You can also add honey to his wet food until you get mc and hc. It works fast but goes away fast so you might need to add some every 20 minutes and keep checking his bg. That’s easy with the Libre.

I read all of the stickies probably 3 times a day at this point! lol I head to it a lot. Unfortunately my experience hasn't quite matched (because ECID I suppose), and like I mentioned, he often tends to be lowest at right at injection time (or 1-2 hours later - see January 20th AM and January 22nd PM).

We got a bunch of cans of the Fancy Feast Grilled with Gravy and even a few of the Gravy Lovers for next time and we do have honey on hand.

I'm just worried that reducing by 0.25 won't be enough based on how low he went when he started over 200. Should also I continue the advice of "between 150-200 give a token dose of 10-25%"? I can't seem to learn how he reacts to insulin and base it on that because so far he's been fairly unpredictable. I struggle so much with trying to figure out the right thing to do, especially with things like when he's jumping just above and below 150 at preshot. I have no idea what number will be safe to shoot at tonight and if it should be 1.75 or even lower (etc).

 

[tiffmaxee]

He was in safe numbers, just lower than you have seen and earns a reduction with SLGS. If you were following TR you would not reduce. If he drops under 90 tonight you would go down to 1.5 tomorrow morning. He is spending a long time in pancreas healing bg.

 

[Brianna & Xander]

He was in safe numbers, just lower than you have seen and earns a reduction with SLGS. If you were following TR you would not reduce. If he drops under 90 tonight you would go down to 1.5 tomorrow morning. He is spending a long time in pancreas healing bg.

Okay, thank you. Is there a certain cutoff, like for example I should only give the 1.75 tonight if he's over 200?

And if the numbers are safe (down to 50), should I not give him anything to try to stop the drop if he seems to be decreasing quickly in that direction? Just wait until he actually does hit 50 before I do any intervention?

Thank you for the advice. I'm sorry if I'm annoying. I'm just so afraid to hurt him and having clear instruction (if situation A, do action B / if situation C, do action D) helps.

 

[tiffmaxee]

Great questions! You are not at all annoying. We all have been in your shoes. Green is scary at first but soon becomes addictive! That’s when many following SLGS decide to switch to TR.

If lower than 200, as you learn how he responds to food at shot time if lower than 200, we will see what reduced dose works for him. BTW the carbs are in the gravy and not so much in the food. Rather than giving you alternatives based upon the pmbg, let’s see what happens. As Angela said, a lot can change before pmps. I expect to see a bounce.

If you are not feeding sooner than 2 hours before insulin you won’t have a food influenced bg. It will be a little influenced if feeding hc at that time. I am in your time zone. I’ll try and check back. You shoot at 8:00 our time? Is it almost +9?

 

[Laurie&Petey]

And if the numbers are safe (down to 50), should I not give him anything to try to stop the drop if he seems to be decreasing quickly in that direction

Not sure I can offer much advice, I'm only 6 days more experienced than you with this but I've had similar questions and fears. They always ask if I tested the low libre numbers with a hand held... when I did, Petey was always higher on the alphatrak handheld.

Petey also seems to go low late in his cycle too and I stalled a few times because of it, including last night and I decided to only give a token dose cause I was afraid to see his new low number. He paid a price today for that decision but he was safe. I have a hard time trusting he always goes back up! Petey always bounces after his first good surf or I sabotage it!

 

[Brianna & Xander]

Great questions! You are not at all annoying. We all have been in your shoes. Green is scary at first but soon becomes addictive! That’s when many following SLGS decide to switch to TR.

If lower than 200, as you learn how he responds to food at shot time if lower than 200, we will see what reduced dose works for him. BTW the carbs are in the gravy and not so much in the food. Rather than giving you alternatives based upon the pmbg, let’s see what happens. As Angela said, a lot can change before pmps. I expect to see a bounce.

If you are not feeding sooner than 2 hours before insulin you won’t have a food influenced bg. It will be a little influenced if feeding hc at that time. I am in your time zone. I’ll try and check back. You shoot at 8:00 our time? Is it almost +9?

Thank you! I appreciate the understanding. It's all definitely scary to me!

The gravy tip is great to know, thank you.

I shoot at 8:30 our time (Pacific). Our schedule is a little weird because he's a little weird - I give him 1.5 oz of FF Classic Pate at 5:45 - 6 with Gabapentin mixed in because he's hard to inject if I don't. Unfortunately if it's any less food than that he tastes it and won't eat it. I note the AMPS/PMPS at 8 and then give him the other 1.5 oz of the can right after. He doesn't eat a whole lot at once so I have to give him a tiny window to graze on it. With the Libre I'm kind of able to just see the numbers all the time, which is helpful too for our weird little feed/shoot schedule.

The only HC food I give now is the little bit I leave out overnight just in case (which he doesn't usually touch), and today when he was scaring me going so low. Other than that he eats Fancy Feast Classic Pate for every "meal."

 

[Brianna & Xander]

Not sure I can offer much advice, I'm only 6 days more experienced than you with this but I've had similar questions and fears. They always ask if I tested the low libre numbers with a hand held... when I did, Petey was always higher on the alphatrak handheld.

Petey also seems to go low late in his cycle too and I stalled a few times because of it, including last night and I decided to only give a token dose cause I was afraid to see his new low number. He paid a price today for that decision but he was safe. I have a hard time trusting he always goes back up! Petey always bounces after his first good surf or I sabotage it!

I'm sorry that you can relate, but I'm glad I'm not entirely alone!

I just did the same thing (skipped on Monday morning, gave a token dose on Wednesday night) and both times like you said, it was obvious that he kinda paid for it. He was high. But it was better than risking him being hurt! I have the same issue; I worry that it's going to keep falling and I don't know at what point to intervene.

I feel like I'm doing the same thing, he has a good day and I ruin it by worrying about how low he is pre-shot. But today I actually felt confident and look what happened lol

Thank you for chiming in! I appreciate knowing I'm not alone.

 

[Laurie&Petey]

But today I actually felt confident and look what happened lol

He's having a good surf day Mama Petey didn't have any greens yesterday and I freaked! I have noticed Petey really sleepy and unsocial when he's low... I think I'm just used to his restless, starving HI's.

I see Xander is on gabapentin that must make him drowsy too.

Wishing you both an easy peasy night.

 

[Brianna & Xander]

He's having a good surf day Mama Petey didn't have any greens yesterday and I freaked! I have noticed Petey really sleepy and unsocial when he's low... I think I'm just used to his restless, starving HI's.

I see Xander is on gabapentin that must make him drowsy too.

Wishing you both an easy peasy night.

Is it a good day? I know they're (generally) good numbers but I'm so stressed out. lol I'm terrified at the idea of giving him another dose tonight when he's still hovering around 79-100 right now with it 2 hours away!

Thank you for the well wishes, same to you and Petey!

 

[tiffmaxee]

The cycle was good for him but I understand not for you.

 

[Brianna & Xander]

The cycle was good for him but I understand not for you.

Yeah, definitely not a great one for me. But hopefully this all gets less scary.

He was back down to 54 on the Libre half an hour ago and is at 90 now. He's asking for food but I'm trying to hold off til 8.

I went and got some half unit syringes so I'll have those, but I admit I'm terrified at the idea of giving him anything if he doesn't even hit 100 or 150.

 

[tiffmaxee]

I don’t think that you should shoot anything if under 150. If you need to skip we need to find a dose you can shoot every 12 hours. If you skip 1.75 should be tried. What do you think?

 

[Brianna & Xander]

I don’t think that you should shoot anything if under 150. If you need to skip we need to find a dose you can shoot every 12 hours. If you skip 1.75 should be tried. What do you think?

Thank you SO much for coming back; I can't express how much I appreciate it!

He's been so up and down. Was back down to 62 at 7:35, now he's at 106. So based on your advice, I'll skip tonight's dose and assuming he's not somehow still low in the morning, I'd try the 1.75 at that point?

 

[tiffmaxee]

Thank you SO much for coming back; I can't express how much I appreciate it!

He's been so up and down. Was back down to 62 at 7:35, now he's at 106. So based on your advice, I'll skip tonight's dose and assuming he's not somehow still low in the morning, I'd try the 1.75 at that point?

You’re welcome. That’s what I would do. Not shooting tonight should drain the depot. What insulin was he on at first?

 

[Brianna & Xander]

You’re welcome. That’s what I would do. Not shooting tonight should drain the depot. What insulin was he on at first?

I appreciate you so much! This has been such a scary day (for me).

He was on Prozinc at first, but the duration of action was very short (a few hours, sharp drop and then steep climb) so he was switched to Lantus as of January 15th.

 

[tiffmaxee]

I think he likes Lantus! Is the gaba because he’s hard to handle?

 

[Brianna & Xander]

I think he likes Lantus! Is the gaba because he’s hard to handle?

It sure seems to work better for him!

Yeah, he's always been a very sensitive and nervous boy, so injections were really difficult. After he turned and bit me once the vet gave us the Gabapentin to calm him and licodaine to help numb the area. Those made a big difference! It's not perfect now but it's at least not awful anymore.

He's still jumping around a lot. Went up to 114 and now back down to 62. I don't know what to make of it. I think the low glucose alarm is going to be going off all night.

 

[tiffmaxee]

Is he grazing? Eating can temporarily raise his BG. Overall I think it usually levels them out. Is there any way to turn off the alarm ur set or higher? The Libre often reads lower than an ear prick, especially in lower BG.

 

[Brianna & Xander]

Is he grazing? Eating can temporarily raise his BG. Overall I think it usually levels them out. Is there any way to turn off the alarm ur set or higher? The Libre often reads lower than an ear prick, especially in lower BG.

He's eaten most of his dinner and I'm gonna leave the rest out for him to go back to. I was also planning to take out his dry food for him to graze on overnight as he wants to.

I originally had the alarm set higher but then it was going off even more! lol I think I did find a way to turn the volume down a little though. Right now it's set to tell me if he goes under 70 and then under 55. I'd be afraid to turn them off and then sleep through it if he needs help!

 

[Laurie&Petey]

It sure seems to work better for him!

Yeah, he's always been a very sensitive and nervous boy, so injections were really difficult. After he turned and bit me once the vet gave us the Gabapentin to calm him and licodaine to help numb the area. Those made a big difference! It's not perfect now but it's at least not awful anymore.

He's still jumping around a lot. Went up to 114 and now back down to 62. I don't know what to make of it. I think the low glucose alarm is going to be going off all night.

So glad you had someone with experience there for you last night. The jumping around is pretty common with the libre, drove me mad to watch.

Not sure if it will be helpful to you but I watched these videos that helped me wrap my head around blood BG vs. Interstitial fluid BG...

Some of Petey's daily numbers were sharp up and down all day, it's like his body is testing out new lows then trying to protect him over and over till it felt safe to let him relax in the 2's.

 

[Brianna & Xander]

So glad you had someone with experience there for you last night. The jumping around is pretty common with the libre, drove me mad to watch.

Not sure if it will be helpful to you but I watched these videos that helped me wrap my head around blood BG vs. Interstitial fluid BG...

Some of Petey's daily numbers were sharp up and down all day, it's like his body is testing out new lows then trying to protect him over and over till it felt safe to let him relax in the 2's.

I'm so grateful someone with experience was able to help too! It's so hard to do this alone, especially when the numbers are new and scary.

I appreciate the links! Funnily enough, I watched both of those last night for this reason! lol

So with Petey, the up and down eventually stopped? That's hopeful news!! Do you know about how long that took?

Also just noticed that Petey and Xander were diagnosed less than a week apart!

 

[Laurie&Petey]

I'm so grateful someone with experience was able to help too! It's so hard to do this alone, especially when the numbers are new and scary.

I appreciate the links! Funnily enough, I watched both of those last night for this reason! lol

So with Petey, the up and down eventually stopped? That's hopeful news!! Do you know about how long that took?

Also just noticed that Petey and Xander were diagnosed less than a week apart!

Yes, we are on this journey together, right from the start! There are links on two dates in Petey's spreadsheet for 15th and 17th, you can see his ups and downs measured by the libre... especially the 17th, then on the 18th he had a steady day... these up and down days always seem to proceed or follow a "new low". Sadly, right when he was heading to his new low he took the sensor off! Panic ensued

Is Xander food driven? I feed Petey on the dining room table and give him his shot while he's busy eating -he became a willing participant pretty quickly!

 

[Brianna & Xander]

Yes, we are on this journey together, right from the start! There are links on two dates in Petey's spreadsheet for 15th and 17th, you can see his ups and downs measured by the libre... especially the 17th, then on the 18th he had a steady day... these up and down days always seem to proceed or follow a "new low". Sadly, right when he was heading to his new low he took the sensor off! Panic ensued

Ah, yeah, I see that! They're not quite as big of jumps but he's absolutely doing that too! Like there's the big spikes but all through the middle he's going up and down like that. It's weird.

Is Xander food driven? I feed Petey on the dining room table and give him his shot while he's busy eating -he became a willing participant pretty quickly!

Very, when it comes to Churus! I give him a whole Churu for each injection and he races onto my desk to get it lol The Churu + Gabapentin + lidocaine have been so helpful.