11/1 Dewee Sugars bouncing

[Jeanie B.]

Hi,

I am pretty new to this (1 week) and my girl's sugars are all over the place. Her AMPS and PMPS are typically (but not always) on the high side. We are offering her wet food (FF pate, Merrick pate) approximately 5-6 times per day. She is a grazer but won't eat the wet food if it doesn't look fresh. (We are adding water to refresh it.) and refuses it sometimes even if it is fresh. There is a small amount of dry food in our room in case she wants to eat overnight (Nature's Instinct limited ingredient turkey) and there is Science Diet in another room for our other cats. (I have not seen her go into the other room but I can't guarantee she isn't.) We have a vet appointment (internal medicine) on Thursday and I am waiting to make any dry food changes until after we talk with her. (I did reach out to those companies who make the recommended dry foods for samples already).

Can someone with experience look at her spreadsheet and give me some feedback? The bouncing is freaking me out. I am worried we won't be able to get this under control. (I updated my signature today with pertinent background and hopefully my spreadsheet is inserted correctly and updating!)

 

[Wendy&Neko]

Hello and welcome,

my girl's sugars are all over the place.

Number one phrase made by people with new diabetic cat. It's extremely frustrating and completely normal. Her little body isn't used to normal blood sugar numbers yet. One more thing, regulation is a process that takes time. Try not to worry it takes a while to get regulation. One of our favourite phrases here is that's it's a marathon, not a sprint.

One thing I will note on the spreadsheet, is that you saw a 41 a couple days ago. I know that's the Libre and it's always helpful to have a human meter to verify that number, but if she really is going that low, you need to reduce the dose down to 0.25 units. In fact, if there is any dry in the picture (and there is), you have to reduce the dose if she goes below 90.

Do you have any data from last night? I'm afraid it's possible she went low again last night, hence the ugly bounce this morning. Lowering the dose may help reduce those swings.

 

[Wendy&Neko]

One more thing I meant to add, are you testing her for ketones at home? This can be done with urine test strips (Ketostix) or a blood ketone meter if kitty is shy about her LB habits. It's extremely important to keep on top of ketones with her history of DKA.

 

[Jeanie B.]

Thank you for your reply. I appreciate the reassurance. We did not test overnight as we don't have the convenience of the Libre anymore and right now it is a two person job to do the stick and read. (I know it will get easier but we are just getting used to this.). My husband stayed up late to make sure she got some additional wet food around 1:00am but I went to bed. (I am on the early shift; he's on the late one!). I did buy Ketostix and tested her once after she came home and the Libre read 'HIGH' and she was 'negative -trace' for ketones.
Am I correct, if their sugar goes too low there might be a rebound of too high hence your recommendation to drop to .25units?
And, are there any syringes where it is easier to estimate .25u? I have Walgreens 1/3 cc syringes that has a half unit mark and can use those but it will be a challenge.
I know the Alphatrac has more expensive strips but is it worth having one to do a double check in certain instances?

 

[Wendy&Neko]

I never used the Alphatrak, mostly because they weren't being marketing heavily or even at all to vets when we started. My vet used the Bayer Onetouch human meter too. Our dosing methods were created before the AT was a thing, and have been tested on hundreds of cats with human meters. So we go by the human meter numbers. One of our dosing methods (Tight Regulation protocol) says to reduce if they go below 50, the other method (SLGS or start low go slow) says to reduce if they go below 90. You have to follow SLGS if feeding dry food. And yes, if they drop lower than they are used to, or drop fast, they could bounce up to higher numbers.

If testing is a two person thing, can you get at least a +2 test as a "before bed" test? If it's a drop from the PMPS test, make sure she has food available at night to keep her safe, you might even need a later night test with a big drop.

I would try to get a ketones test daily for the next while if you can. DKA is too recent in her history to slow that down. Glad she's tested negative at home. Every time you do a ketones test, could you write the result on the spreadsheet in the Remarks? That way we'll stop asking.

In the Sticky Note on Insulin Care and Syringe Info, there are some pictures of how to estimate 0.25 units.