10/29 New Member - dropping to low BGs

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Elise & Gus

Elise & Gus

Member Since 2022
Hello!

We’ve had drops to some low BGs over the past few days and would love to get some thoughts/advice on what might be going on. Starting off at the top here with some background but feel free to skip ahead to the “questions” portion.

Background:

New member. Gus was just diagnosed one month ago and we’ve been reading many of the posts on here over the past few weeks and have learned a lot, but definitely have more to learn! In addition to diabetes, Gus also has asthma, IBD, hyperthyroidism, and mild heart disease. Profile has a complete list of meds and doses. His diabetes was caused by steroids he was taking for the IBD and asthma, so we are no longer on those. Diet is Blue Buffalo Hydrolyzed dry and wet food and he free feeds throughout the day. Insulin is Lantus. Meter is Alpha Trak 2. We started off at 1 unit every 12 hours and after two different glucose curves done at the vet we are now at 3 units every 12 hours. Overall he’s mostly behaving normal and definitely has improved with the weeks. Hard to say for certain what’s a symptom and what’s normal- might still be slightly fatigued and might be slightly under-eating from his pre-diagnosis self.

Quick Disclaimer:

Having now read a lot more of the posts we are unfortunately light on data. My vet, sadly, is fairly anti-at home testing so we initially delayed on getting a glucometer. After telling her I got one anyway, I asked how often we should test and her response was “occasionally”. So I wasn’t aware of the recommended pre-shooting tests until just a few days ago (sigh). We also skipped days here and there and I have practically no PM readings. At least now I know for the future. On the spreadsheet I only included days I have data for, but let me know if it is helpful to add in days with no data just so gaps in data are more obvious.

Questions:

As you can see from his spreadsheet, Gus was registering high numbers on 1 and then 2 units. 2 units was especially concerning since it actually went up for some reason. Would love if anyone has an idea what might have caused that?

We actually had a third glucose curve scheduled with the vet on 10/26, but due to his more-normal behavior decided to push one additional week to 11/2. Decided to do my own at-home curve on 10/26 instead. Abruptly on 10/26 we dropped down to AMPS 176. (really kicking myself I didn’t do any readings on 10/25). I was actually so shocked to see a number below 300 for the first time it completely freaked me out. At +4 went down to 66- which started to get me even more nervous since vet’s one piece of advice was call if it was below 60. Furiously read posts on this forum all afternoon and skipped insulin that night since PMPS was only 116

Next day back in the 300/400s. And then this morning took a AMPS and it registered at 80. Called vet and confirmed what I had already decided, which was to skip AM shot. As I explained to the vet- I don’t know if I’m just being overly cautious but it seems really jarring we suddenly are so low. Vet also said the 66 number on 10/26 was “concerning”. Vet’s advice was to see what PMPS number is, give insulin depending on number and recheck in morning. He’s back up to 371 PMPS and I will continue to update the spreadsheet, but I would love anyone’s take on what might be going on. My gut says we’re at too high a dose and I’m worried staying at 3 units we will go into hypo one of these times. Can’t get in to see the vet until Wed for another curve sadly. Thanks in advance for any thoughts!
 
Hi and welcome to the forum. I am very glad you are seeking some help.
Well done setting up the spreadsheet and the signature and doing some hometesting. Many vets ae not keen on hometestomg but it is the only way to keep Gus safe.

Looking at your spreadsheet I can see you are on too high a dose. As you are using the alphatrak meter, you need to reduce the dose if the BG drops under 90 if you are following SLGS. If you are following TR you reduce the dose at 68
Either way, the BG dropped under both those numbers so you need to reduce the dose to 2.75 units.
The reason you are seeing low numbers then high numbers is because Gus is bouncing, which is very normal in newly diagnosed cats.
From The basics:
  • 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).
Tis is what I would suggest/ recommend you do:
  • Test before every dose to see it is safe to give the dose. As you are new to all this, if the preshot BG is under 220 (using the alphatrak meter) I would stall, don’t feed and test again in20 minutes to see if the BG is rising. Post and ask for help
  • Try and get at least one test in every cycle during the cycle to see how low the dose is taking Gus. The nadir or lowest point is what we base the dosing on…not the preshot number
  • Test/ feed then shoot in that order. Give a main meal before the shots and give at least 2 snacks during the first half of all cycles
  • Do you have a hypo kit set up? HELP US HELP YOU has information about the hypo kit and other useful information for new members.
  • Read the yellow stickies at the top of the Lantus page.
  • Post daily and ask for advice and get us to look at how Gus is going. Once we get you sorted out I will get you to post over on the Lantus page.
  • Bron

.
 
Welcome to FDMB!

I agree with Bron. It's very likely that your dose is too high. One of the reasons we advocate so strongly for home testing is what you've been experiencing. If you don't test, or test infrequently, you may miss the lower numbers. In addition, while it can be confusing, for most of our kitties, if they are in the early stages of your managing their diabetes, their numbers may drop lower and then since they are no longer used to being in a normal blood glucose range, their numbers spike back to a higher range. We refer to this as a "bounce." Gus's body is overreacting to the lower numbers and his liver and pancreas release a stored form of glucose along with counterregulatory hormones that spike the numbers. This is a normal phenomenon and one which is very annoying to the caregiver who's really trying to get the numbers to come down!

We also encourage finding a dose that will let you shoot twice a day. As you're seeing, between the bounce and skipping a shot, numbers are back in the >300 vicinity. Also, we don't encourage increasing the dose by more than 0.5u and then, only if the nadirs are over 300. Typically, doses are raised by 0.25u so you don't miss what may be a good dose for your cat.

If you've not had a chance to read the sticky notes on the Lantus board, you may want to take a look. Bron mentioned the two dosing methods that we use with Lantus and you can find more detailed information in the sticky on dosing on the Lantus board.

One other note, we're not big fans of dry food. I'm not sure which of the dry Blue Buffalo foods you're using but I suspect it's quite high in carbohydrates. Along with the carbs, cats do not have a huge thirst drive. Canned food is far better for them. Given Gus' IBD, you may want to consider a diet of novel proteins (e.g., venison, rabbit, lamb). There is a great site for kitties with IBD. They focus more on a raw diet but there is great information about feline IBD -- supplements, symptom management, etc.
 
Thank you so much for the responses! Glad to know I'm not crazy. Will take the AMPS in about 30 mins and assuming above 220 will try 2.75 units. I definitely need to read up more on the two dosing methods, only did a single read through of those initially!

This is such a dumb question, but I want to make sure I'm not missing something obvious- to get to the 2.75 you just do your best to hit between the 2.5 and 3.0 markings on the syringe, correct? I haven't seen any mentions or found a syringe brand with .25 markings, so just want to be sure.

Gus's IBD (DX 06/2021) primarily presents itself as vomiting, which is oh so fun. We tried a novel rabbit diet initially and everything kept coming back up, so we've had much better luck with hydrolyzed diets. But I can look into the various hydrolyzed offerings and see if there are differences in the protein/carb amounts. The hydrolyzed cans in my experience are all pates and he really loved his old brand of food in gravy, so he's never quite liked the new pate can food, but he will tolerate it so I can try shifting more heavily towards that as well.

We do have supplies for the hypo kit! Really hoping not to need it <3
 
Updates! PM+10 was 192 so I was feeling pretty good we'd be in line to shoot this morning. But AMPS is now at 128. So holding for now and will recheck in 30 mins to one hour.
 
+2 after we were aiming to shoot and we are still at 131. Confirmed with vet to skip this morning. Will continue to take readings through the day and see about doing 2.75 units tonight
 
Elise & Gus said:
This is such a dumb question, but I want to make sure I'm not missing something obvious- to get to the 2.75 you just do your best to hit between the 2.5 and 3.0 markings on the syringe, correct? I haven't seen any mentions or found a syringe brand with .25 markings, so just want to be sure.
Click to expand...
Yes you are correct, just eyeball it. You do have the syringes with the half unit marking I assume. Unfortunately no syringes with 0.25 markings
30-unit-insulin-syringe-markings.jpg
 
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