1.12.23. Hypo Help

Sarah & Charlie-cat

Sarah & Charlie-cat

Member Since 2022
Long story short: I'm not sure what to do about Charlie hitting 70 tonight. The AAHA decision tree says, no symptoms of hypo but below 80, reduce dose. Also not sure what to do about predose numbers like 91 and 120. Should I be reducing doses? Is this normal after 3 weeks?

I have gotten pee strips to test for ketones and some non-absorbent litter. Going to have to figure out how to isolate him long enough to get a pee without the other five messing it up.

Spreadsheet:
https://docs.google.com/spreadsheet...WDunDbVvf5f-iEjgHchCTpzfkQw/edit?usp=drivesdk

Long story long:

Charlie was diagnosed with pancreatitis and diabetes while I was traveling for work. My husband took him in and we had a conference call with the vet. I didn't get anything about whether they did a ketones test or the results, likewise fructosamine test. Picked him up, learned to give insulin, sent us on our Merry (anxious) way with a reduced steroid dose (he developed an autoimmune immune blood clotting problem after a round of vaccines 1.5 years ago)

My vet's office has continued to insist on pre-shot BG once a week. At the first, a vet we haven't seen before raised his dose from 1u to 2 u Lantus. They had him on the Hills I/D canned he was on when they hospitalized him with pancreatitis. He dropped about 4-5lb through all of this but has been steady for the last 3 weeks.

At the second, I was like hey, I don't want to pay 3 dollars a can for food that is higher in carbs than is necessary. So, we agreed to make that switch and the next week his preshot numbers there were in the low 200s, which is what I got at home too. He is now getting 2.5 cans of FF chicken and liver pate. 1 full can am and pm before his shots and .25 around 5 (what used to be first dinner) and the other at bedtime.

I have been struggling to get enough blood or an ear poke at all from him, despite lots of good advice and occasionally an extra set of hands. But I did manage to get a +4 from him one day and it was 76. So, I gave him a little extra food and it came up to 86. I reduced the dose to 1.75. which feels impossible to measure in those tiny syringes.

The next not our normal vet was grouchy when I explained that when she called after our tech visit (just took a BG reading). We saw her this week and his BG was 91 (from a extra pad stick while he was in a full nelson with me). I was like hey, that seems low for a preshot number and she grudgingly agreed I should give him a lower dose that morning and to reduce the dose to 1.5u. I was pretty sure I got part of his dose on and not in him (new syringes, got ones with the half u marks).

And she agreed to stick a freestyle libre on him rather than do an in hospital curve. Today, he was running 88 at +4 am and 70 at +2pm (he got a little extra of his regular food) and he's back in the mid 80s.

So, the AAHA decision tree says if he's under 80 at the nadir, reduce the dose and redo the curve. So, that makes sense and I can do that. But I'm just having a hard time understanding what is going on here that he's turned around so fast after throwing low 400s numbers on week 1 and 2 of rechecks.

Link to previous post: https://felinediabetes.com/FDMB/threads/dosing-questions-on-lantus-charlie-cat-sarah.271961/
 
Max had chronic pancreatitis and I fed him lc fancy feast pates. Diet does not usually lead to bouts of pancreatitis with cats like it does with dogs and humans.
Here’s your previous post for continuity.

With SLGS you reduce the dose if ever you see a bg under 90 in a cycle. Then you hold that dise 7 days unless another decrease is earned.
 
Yes, so he earned a decrease last night (and yesterday clocking in at 88, 70, and 84). I shot a smidge under 1.5u this morning. I need to go find some reading glasses. My poor eyeballs had a hard time even with the half unit marks!

That was my original concern is that the vet moved him up a whole u based on pre-shot numbers not nadir. And then we did a diet change when another vet at that practice was like we can go up with insulin or down with steroids and I was like hey, since I'm paying an arm and a leg for food that has more carbs that strictly necessary, let's try diet and she was like ok. Did that and what little data I was able to get suggested that 2 u was too high.

Happy to stay at a smidge under 1.5 for 7 days if he doesn't drop below 90 again today/tonight.

He dropped from pre-shot numbers in the 400s to 100s in three weeks. I think my meter is 20 off theirs but I can't remember what direction and then not sure about the Freestyle Libre.
 
Some cats are really sensitive to carbs, too. Jackson’s current high run I’m pretty sure traces back to a handful of treats he was given (grr!) by a well meaning yet wrong family member - days ago. It’s possible that just changing to a lower carb diet might have been the edge Charlie needed to get out of the reds down to yellows, and really let the Lantus work.
 
He's now in blues and greens.

I weirdly didn't notice anything after the vet tech gave him a bunch of normal treats the other day after she tested him at 91 preshot. No more normal treats here, just dehydrated fish and shrimp. Well, duck too but I haven't tried that yet.

I need to toss what we have in the house. The others very rarely get treats. Mainly they're around for luring Charlie into a crate. Oh hi, I would like a treat. Drat, am in crate.

I'll take a look at the pancreatitis stuff. He was intermittently throwing up for several months before he stopped eating and looked like he would quite like to be left to die next to the water bowl
 
Max would become inappetent when he had a bout of pancreatitis every time so I would start him on ondansetron for nausea whenever his appetite decreased. When diagnosed it was Thanksgiving and he stopped eating. Sometimes he would appear to be in pain but not always. He got buprenorphine when that happened as pancreatitis can be quite painful. I was surprised to learn that just because he wasn’t vomiting didn’t mean he wasn’t nauseous. I am pretty sure a combination of pancreatitis and a little extra weight led to fd for him.
 
Sarah & Charlie-cat said:
He's now in blues and greens.

I weirdly didn't notice anything after the vet tech gave him a bunch of normal treats the other day after she tested him at 91 preshot. No more normal treats here, just dehydrated fish and shrimp. Well, duck too but I haven't tried that yet.

I need to toss what we have in the house. The others very rarely get treats. Mainly they're around for luring Charlie into a crate. Oh hi, I would like a treat. Drat, am in crate.

I'll take a look at the pancreatitis stuff. He was intermittently throwing up for several months before he stopped eating and looked like he would quite like to be left to die next to the water bowl
Click to expand...

Charlie may not be as sensitive as Jack to a few treats, heh. But the main diet change could have done it.

And yes, resolving underlying pancreatitis could definitely have done it.
 
Yeah, he's clearly feeling so much better! It seems like resolving pancreatitis, changing diet, decreasing steroids have done a lot to help lower his BG. I just don't want to be giving him too much and having him go hypoglycemic on me. I am absolutely useless in emergencies. And why put me or him or the emergency vet over the holiday through that if it's preventable?
 
He's at 68 now. Couldn't tell if he was a little wobbly or if his jaunty polka dot collar was wobbling. He was thrilled for a snacky (his regular FF) and the dried minnow I thought would distract him long enough for an ear stick. Dear reader, he was not distracted by the giant treat with eyes long enough to manage more than some pets, a futile attempt to warm his ears up with my icy hands, a smear of Vaseline and a couple ear sticks that didn't bleed. I need a little microwave up here next to the tiny fridge his Insulin is in so I don't forget to bring it downstairs. He proceeded to hide under the bed and is now begging for more lil fishies with the eye ballz and seeing none, ensuring his food bowl has been licked completely clean.
 
I'm thinking I'm going to try 1 u tonight and see what his numbers look like tomorrow and hey, if we could hold him at 1 u for 7 days then that would be super
 
Sarah & Charlie-cat said:
He's at 68 now. Couldn't tell if he was a little wobbly or if his jaunty polka dot collar was wobbling. He was thrilled for a snacky (his regular FF) and the dried minnow I thought would distract him long enough for an ear stick. Dear reader, he was not distracted by the giant treat with eyes long enough to manage more than some pets, a futile attempt to warm his ears up with my icy hands, a smear of Vaseline and a couple ear sticks that didn't bleed. I need a little microwave up here next to the tiny fridge his Insulin is in so I don't forget to bring it downstairs. He proceeded to hide under the bed and is now begging for more lil fishies with the eye ballz and seeing none, ensuring his food bowl has been licked completely clean.
Click to expand...

LOL :joyful: I love the pictures your words paint. Lil fishies with eyeballz…. What we do for our beloved little predators.
 
During the summer of 2020, it was impossible to find their normal canned food, so I tried them on Tiki Cat and I just could not with the sardine one that has eyeballs. Nope! What we do for love.

I think he liked the minnows even better than the salmon or the shrimp!
 
I continue to be confused by Charlie's numbers. At +4 he was down to 81. I reduced his dose over the last few days following the SLGS protocol, which is similar to the AAHA algorithm. His pre-shot number was 189, so obviously, that's above the normal range but under the 200-250 range.

Am I just seeing the effect of moving to a low carb diet? Plus his pancreatitis clearing up? Last week, I thought he was sleeping more than normal in my bed. Today, he was up to shenanigans of running into the basement while I was trying to do laundry and has been chilling downstairs with the rest of the herd.

I did, I think, miss his steroid dose on NYE but he had it last night.
 
Our honeymoon of easy numbers is over. His Freestyle stopped working this morning. I sent the spreadsheet and the link to the AAHA to the vet this morning after calling and asking about next steps and not being able to talk to anyone. The vet, not one of the ones we normally see, emailed me back saying, ok, stay at 0.75 U and repeat a curve in a week. Asked if we could do a Freestyle again because I'm still not able to get a test on him. My husband and I wrestled him and I got not enough blood. I knew it wasn't enough, but I hoped maybe. Nope. I tried again later without any luck. And tonight he barely let me do his steroids in his ear.

I don't think we could constantly have a Freestyle on him... but it would be cheaper than doing a curve at the vet and hopefully more accurate since he wouldn't be stressed at the vet's, especially since he would have to be wrestled by 2 people every time they have to draw blood from him.

I did get hydrophilic litter and a clean box and ketone strips to start testing his pee on a day I can hang out in my bedroom with him all day in the near future.

He certainly has been full of beans lately. No vomit. The water isn't disappearing like it's going out of style. But he still is acting like he's starving but not nearly as bad as it was in the last few months.
 
Charlie got another Libre yesterday. It read under 50 between 3 am and 6 am. Gave a snack of his regular food at 6 am. His 8:30 am preshot was 94. He ate breakfast like a champ. I gave .5 u of his Lantus. His Libre read 51 an hour later. I gave him an 1/8 cup of Purina One, checked again 20 min later. Just said LO. Called vet freaked out, they said to recheck with my meter. Got a 61 reading (also, we're both traumatized). He's now hiding under the dining table not letting me put his pink collar back on and doing a bath.

Next steps? Other than watch him like a hawk, try to get another meter test soon? From the last Libre, his lowest point seems to be around noon. He's got kibble in him so I hope that is a buffer.

I've tried the suggestions for testing him shared here and in the Facebook group but it's been a struggle and was hoping to reset and try to build up to him being more compliant while he had the Libre. I can't warm his ear up with a rice sock if he won't let me touch his ear. It took me easily six tries with a 26 gauge to get his ear to bleed. I got his back accessory pad but he pulled away before I could get the meter to it. He's always been very particular about how he's touched and affection is on his terms. He likes it but he doesn't like being picked up at all etc.
 
Since you’re using a relion, 60 is not considered hypo, so no need to panic! Looks like your kitty’s BG values are on the way up, bouncing from that O/N low.
 
That's good, cuz I'm panicking! The vet left a message to come in and I'm going to see if I can stick him one more time at his +4. He's been enjoying his gravy lovers food, some kibble and a little Karo syrup. I would like not to go back there since I feel like they haven't handled this well at all. If I did what they said he'd still be eating high carb food And getting 2u of insulin a day. Now, he's eating low carb food and decreased his dose. On the last Libre, I lowered him down by a whole U and the vet grudgingly was like fine, keep him there for a week. And here we are.
 
Since you are following SLGS, that 60 means a reduction down to 0.25 units. Charlie's looking good. :D

Could you please remove the 911, this is not a medical emergency now. And a favour to ask, next time you post, could you start a new thread? This one is getting long and dated. Thanks.
POSTING GUIDELINES PLEASE READ
 
You must log in or register to reply here.
Back
Top