? 7/08 Macka after hypoglycemia - PM +12 HI - AM +1 697 +3 561 +6 571 +8 553 +12 470

Penelope and Mačka

Penelope and Mačka

Member Since 2019
http://www.felinediabetes.com/FDMB/...ate-dont-know-what-to-do.216532/#post-2402127 last night's discussion

Hi,

Macka had an hypoglycemia episode last night at 10pm. I panicked and gave him a lot of high carb food. His numbers went from 56 to 644 in a matter of a few hours. He's ok right now but definitely down.
I have not slept a second.

I wrote to my vet to ask her what I should do this morning, in terms of insulin dosage and everything really.
She is saying I should SKIP the morning dose, and then go back to 1 unit for a bit.

Should I feed him at regular hours? What else? what are your thoughts?
Please help me. Thank you
 
Does not make sense to reduce by a full unit. We normally reduce ( or increase) in .25 increments. I think it was suggested to go to 1.75 after the hypo? That makes the most sense as long as preshot number is high enough to shoot. If you skip a dose, you are draining the depot already started. By reducing dose, you are still slightly reducing depot, but the cat is getting insulin still.


Bobbie should have some words of wisdom:)
 
Ok now vet says she recommends 1 unit for a little while. I honestly don't know what to do.
I am afraid that with 1.75, it will be still too strong and hypo again today, tonight etc... Am I understanding wrong?

I just fed him 1/2 can of FF classic. He ate no problem.

Can such high numbers of hyperglycemia kill him?
 
keep in mind that the 58 you got last night was just under the take action number using an AT2 meter

Did Macka show abt signs of hypo. All we use that term hypoglycemic when there are symptoms of being to low such as confusion , lose of coordination , weakness , just to name a few. Otherwise it was a low number. I know it is scary the first few times. But as long as there are no symptoms and Macka is responding to higher carb food and coming up , you are in control.

You’ll also get better at how much higher carb food to give . We’ve all panicked and given too much and sent kitty to the CARB moon.
 
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I am not sure I can monitor every hour today for the reason that I have not slept in days, and definitely not last night. I need rest for more than an hour (going to skip work today). Vet was offering to keep an eye on him today, maybe I should do that?
 
Bobbie And Bubba said:
Did Macka show abt signs of hypo.
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He started to. He was a little confused and shaky. I gave him food right away that he devoured, the rest is in the spreadsheet.
He was in the 400-500 range during the day yesterday, I was not expecting a low number like that. I'm glad I stayed alert and check every one of his movements.
 
Penelope and Mačka said:
I am not sure I can monitor every hour today for the reason that I have not slept in days, and definitely not last night. I need rest for more than an hour (going to skip work today). Vet was offering to keep an eye on him today, maybe I should do that?
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You don’t need to check every hour as high as he is now. I would get a test at +2. If that number is lower than the pre shot number it could indicate an active cycle and some more testing could be necessary. But let your meter guide you with how often.
 
I wanted to add that I read the Go Slow protocol, and they say
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
However, I don't think our low number was a nadir, it just dropped dramatically after the PM shot (+3 174 +4 56) and I have the feeling it was going to go way lower at +5. Please keep in mind he was in the 400-500 range only a few hours before.
I am not trying to contradict your experience, I am just super scared of having the same episode happen again today and the day after if I only reduce by 0.25 units :(
 
Penelope and Mačka said:
He started to. He was a little confused and shaky. I gave him food right away that he devoured, the rest is in the spreadsheet.
He was in the 400-500 range during the day yesterday, I was not expecting a low number like that. I'm glad I stayed alert and check every one of his movements.
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I'm sure this is really scary, and I really feel for you, although I don't have any experience to help and will leave that to more knowledgeable members.

May I ask, did you decide to test because of his behavior? Or did you happen to test at +4 and realize the low primarily through the BG number? Figaro has been in the 400s for several days, which is driving me kind of crazy, and I am also worried about seeing a sudden drop.
 
Penelope and Mačka said:
Now the Alpha Track says HI :'(
What's going on???
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He is bouncing from yesterday’s lower number. Remember , they will bounce from any lower number than than are used to. If all his numbers have been in the 450 range, ( as an example)and he throws a blue number , that blue number can cause a bounce. It’s all relative and bouncing is part of the dance and all you can do is let it clear which can take up to 6 cycles.

Did you give insulin yet? I would strongly suggest for you to shoot the reduced dose of 1.75. WE need to get him out of these high numbers. Also I just wanted to add that a DKA event is much more serious than a low number. As I mentioned before you have control with your meter and higher carb food. You have no control with DKA.

The recipe for DKA to happen in: Not enough insulin, a systemic stress or infection and in appetence.
 
Penelope, you're doing a really great job, don't panic! I bet that Macka is just bouncing from his low numbers. He won't die :).

I think you've gotten some good advice to reduce by 0.25 units for a dose of 1.75u, like the others said, due to his recent DKA experience you really don't want to skip doses. I understand you're nervous but a full unit decrease is huge... if you absolutely aren't comfortable with 1.75u maybe try 1.5u instead, Macka is your cat so you know what is best. Like Bobbie said, you wont need to test every hour, get your +2 and see how he is trending it could be that Macka will be in a bounce all day.
 
Bobbie And Bubba said:
He is bouncing from yesterday’s lower number. Remember , they will bounce from any lower number than than are used to. If all his numbers have been in the 450 range, ( as an example)and he throws a blue number , that blue number can cause a bounce. It’s all relative and bouncing is part of the dance and all you can do is let it clear which can take up to 6 cycles.

Did you give insulin yet? I would strongly suggest for you to shoot the reduced dose of 1.75. WE need to get him out of these high numbers. Also I just wanted to add that a DKA event is much more serious than a low number. As I mentioned before you have control with your meter and higher carb food. You have no control with DKA.

The recipe for DKA to happen in: Not enough insulin, a systemic stress or infection and in appetence.
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Totally agree
 
Hi all,

Macka is at the vet all day for a better monitoring. His pre-shot numbers went from HI to 671. Still high, but going in the right direction I suppose. I wonder if it's because they test on the paw and not the ear like I do. He had his decrease of insulin. He ate very well at 7am, and would even eat some more if he could. I left some fancy feast cans to the vet. Vet said that the high numbers will likely not be threatening, they usually are if they are left uncontrolled for some time. It reassured me a little because I though I was losing him in the HIs. Vet also confirmed the somogyi effect.

@Figaro's Liz I know exactly how you feel, I think we're on the same boat at the same time. Here's how it happened: he had very high numbers during the day yesterday, so i though I did not need to take a pre-shot measurement and would check after the shot +2. He was looking very alert and healthy out of a sudden when I checked his blood and it was an unbelievable 174. I thought it was dropping a little too much too soon, so I checked again an hour later and there he was in the light greens. At that point, he was a little disoriented and shaky, but very slightly. He was very hungry.
So my take on this is, never miss a pre-shot, test more, always finish a 6 cycle before changing the insulin dose (I went from 1.75 to 2 too soon), do feed him high carbs if cat is in low numbers but not a ton like i did. I literally threw the bag of kibbles at him.
 
His ketones tested negative.
He is grumpy and tired, but he ate a good amount of food today (approx 2 cans).
His numbers are back in the 400 (pre-shot), but now I don't know how I can go to sleep after what happened last night (I could sleep a little while he was at the vet). I am so scared of a new low number/drop episode.

Should I test every 2-3 hours tonight? What is a safe number at PM +3 so I can maybe try to sleep?
 
Why don't you get a +2 to start, and post here. The +2 is often a good indicator of how the cycle will go.

It'll help if you change your subject line to reflect current numbers. That way it's easier for us to keep an eye on you at a glance at the board.
 
It looks like you only shot 1 unit tonight. Reducing the dose too much is not good for a cat with recent DKA. Tomorrow's dose would be 1.75 units.

Now that your first low numbers event is over, there are a few things to learn from this. First of all, did Macka show any hypo signs last night, or was it just a "low numbers" event? Many kitties don't show any signs it they are a little bit below the reduction point, but each cat is different. It's good to know if Macka had hypo symptoms or not. All Neko ever showed was hunger.

Food is an important tool whenever numbers go low. Keep track not only of the type of food you fed, but when and quantities. I used to add notes like "1 tsp HC@+4.5" to my spreadsheet Remarks section. That way I could see the effect of the food and know what worked or didn't work before. Since a cats pancreas can heal, there is a good chance you will see lower numbers again. But once you are monitoring and have the proper tools (food), you can control the numbers. Make sure you always have plenty of test strips around, maybe put an extra bottle away for low numbers events. Always have high carb food and/or karo/honey around. Over time you will learn how Macka responds to carbs and this will become much easier.

You had two posts yesterday, here is the link to the first one. Having just one post a day helps us keep information together and ensures nothing gets missed. In your first post yesterday, I said "
Looks to me like Macka is bouncing from the low yellows or possible blues from the night of the 4th. Bounces can take six cycles to resolve, so I would expect better numbers tonight or tomorrow during the day.
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Macka broke his bounce on the sixth cycle. That's an important bit of information that will help you. Over time he may break bounces sooner, but for now, you can probably guess there may be 5 cycles of high numbers before the numbers come down. Since he might have gone lower than what caused his previous bounce, it could be even longer. How can the sixth cycle bounce break information help you? A couple of ways. First, don't fret about the high numbers, they are expected. There isn't anything you can do about it. Second, bounce days are good days to go to work or get out of the house or even get good sleep at night. And most important, be vigilant when you see the sixth cycle after last night.
Penelope and Mačka said:
PMPS = 470 PM +3 (more a +2.5) = 463 : what do you think?
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Go to sleep. The bounce plus reduced dose means he won't do anything worrying tonight. When the +2 is about the same as the preshot, you'll get a normal Lantus cycle with some downward curve. But he's high so won't get too low. When the +2 is a lot lower, which it may have been last night, it's a cycle needing more monitoring. If possible, some people arrange their shot schedule so they can get a +2 before they head out to work. Then depending on the +2 test, decide if they need to leave regular food or high carb food out for kitty.
 
For the people who asked, yes, my vet recommended 1 unit, not 1.75. We talked about it a lot. I mentioned to her what was said on this forum. She understands the adjustments when a curve is a little too low but said that in our case, if an overdose did happen, we needed to cut more than 0.25. I am personally very confused and did not know what to do or who to listen to in priority :/ and finally decided to go with the lower dose, then eventually raise it up again, but not to a 2 units.
 
The one time 1 unit dose will drain the 2.0 unit depot. You didn't give 1.75 units a long enough chance last time to build the depot so you don't know how well it will work. With SLGS which you say you are following, you hold the dose 7 days.
 
Wendy&Neko said:
The bounce plus reduced dose means he won't do anything worrying tonight. When the +2 is about the same as the preshot, you'll get a normal Lantus cycle with some downward curve. But he's high so won't get too low. When the +2 is a lot lower, which it may have been last night, it's a cycle needing more monitoring. If possible, some people arrange their shot schedule so they can get a +2 before they head out to work. Then depending on the +2 test, decide if they need to leave regular food or high carb food out for kitty.
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Thank you so much for all the precious advice. Yes, it's a learning and painful experience. You were absolutely right about the 6th cycle and lower number. It did not really happened with lower units but definitely showed at 2 units.
I stocked on gravy food today and wrote down the number of carbs for each can that I put in the HYPO kit.

Wendy&Neko said:
First of all, did Macka show any hypo signs last night, or was it just a "low numbers" event?
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I am not entirely sure he did apart from hunger. He looked maybe a little confused when walking around the house, but I might have imagined it.
I asked my vet about the recent DKA and a lower insulin dose. She replied that he should be fine because he was eating and receiving some insulin still. I hope... and will keep on monitoring ketones with the urine strips.
 
Wendy&Neko said:
The one time 1 unit dose will drain the 2.0 unit depot. You didn't give 1.75 units a long enough chance last time to build the depot so you don't know how well it will work. With SLGS which you say you are following, you hold the dose 7 days.
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Yes, it's all very new to me. I feel very ashamed and guilty for not keeping the 1.75 unit for 6 cycles. I also do not understand how 1.75 would be beneficial for him right now after the low numbers episode and did not want to risk more overdose. I might understand things wrong with the depot phenomenon etc, I am just so so scared of giving him too much. I am exhausted from a full month of no sleep, hyper stress and anxiety, and my health issues on top of the rest and realize it's hard to make the right decisions. This is all very overwhelming :(
 
Hi Penelope, I am very new here myself so I just want to say that I know exactly how you feel. I also just want to share/repeat a tip from here that has really helped me.

If you look at my boy's SS you'll see that the black and red numbers are no strangers to us either. (Zorro's SS looks like I've been doing this for a while but I only committed to this board's form of TR on June 26, towards the end of the SS. Prior to that I was chopping and changing things, based on those hated black and red numbers that fuelled my emotions and made me lose my head at times.)
I cannot tell you how many times since end Feb this year I've broken down, exhausted and told my partner that I can't do this anymore and I don't know which way anymore. (And I'm certain there are still many more months of similar episodes ahead of us.) Often times this was after a black or red number reading, when I felt so powerless because the insulin was shot, there was nothing further I could do and if he was going to stay in black or red well, then that was it for the next 10 or so hours.
Zorro also looks really miserable when he's HI. I call it the sugar daze. His coat looks static, his pupils are enlarged, he sits in a strained position, staring ahead and only gets up to go and sit in front of the water bowl in the same daze.

You will also notice that I've only very recently had 2 low episodes during which I was terrified but we got through them. Then you'll see that Zorro also "bounced" after those episodes, either by going HI early or by having a few what I call stubborn runs, that just won't budge past pink numbers.
So anyway, I really do understand.

So my tip: I can't yet interpret SS data accurately but as you yourself know by now, a pre-shot reading is non-negotiable. With knowledge of that number, you will then have a bit of control once you have taken your +2 and +3 readings. Thanks to @Wendy&Neko and @Bron and Sheba I now know to feed a bit at +2 if the reading tells me the cycle is an active one, and again at +3. This will help to prevent a too fast drop. I share Zorro's evening meal between those two times (see the notes on his SS) so that he doesn't end up getting extra food, just his normal portion but at the right times. Then you have enough food "allowance" left if you need to feed extra during an actual low. I've also made the mistake of feeding too much during a low. One is so panicked at the time, it is understandable so don't be hard on yourself. Do try to stick to wet/canned food, though.

I have to run now. I can go on for ages!:joyful: but I just wanted to say I know how you feel, try that early testing/feeding tip in a way that works for you and remember, many caring eyes are looking out for you and Macka.

:bighug:
 
Hi @Zorro's mom Maritsa,

Thank you so much for your tips. You nailed it. I am exhausted of all the stress, seeing him being a shadow of himself, feeling powerless, being obsessed and neglecting everything else in my life. I had to stop working, I just can't leave the house. This puts my position in jeopardy but what else can I do? My husband works all day and one of us has to, at least. I see in your SS that you don't sleep much. I am also sleep deprived and that has a big impact on my mental health (and it's only been 1 month, I can't imagine going like that for years). I break down and cry multiple times a day.

Zorro's BG looks all over the place (like Macka's) and has highs and lows during the same day, how do you explain it? Why hasn't it normalized by now? Are you increasing the dose every 6 cycles?

I am taking into consideration your feeding tip. That's what I did yesterday evening, and even left him some FF for the night. He ate it all. So are you saying that you give him insulin without him eating first? In addition, and that's a question for everyone: can low carb food like FF classic influence the glycemia if we give them more than usual? Or can low carb be given endlessly without impacting it? I'm still not sure. Macka can eat and is happy to eat all day, he has always been like this (I rescued him as a kitten from the streets of Croatia, he was malnourished with a broken leg, mange, worms etc etc...).

Thanks again for your encouraging words, they are really appreciated.
 
Hi Penelope,

Like you, I am super new to this, terrified, losing sleep and ignoring lots of other stuff in my life. I'm trying very hard to keep a balance as much as I can, for Figaro's sake. It's a little cheesy, but remember on a plane, you put your oxygen mask on before helping anyone else? Taking care of yourself and your basic needs puts you in a better position to help Macka.

In case this might help, I'd like to share something I often think about, when I am desperate and feeling lost and overwhelmed. My brother is a physicist, very practical, interested in empirical evidence. Once, years ago, I was so distraught about the end of a long and important relationship, I thought my life was over, etc--he had a glass of wine and swirled it around. He said: your life feels like this, tossing and tumultuous... but it will settle, like this (as the wine stopped sloshing). Nothing is ever perfectly still, but these tumultuous times DO subside. Things will get better.

You are doing your best. Remember to take care of yourself. It is not selfish to sleep, or to eat, or to go for a walk, or take a bath, or do whatever can help you relax for a half hour. Macka needs you to be healthy, too. :bighug:
 
Definitely get it. I have not slept through the night in 6 months. I actually set my alarm to wake myself up 2 times every night to check on the cat and feed her. I bought an auto feeder months ago. Have not tried it yet, am afraid it won’t work right and cat will be hungry, she would wake me up anyway, so why set the alarm? What if one time she goes too low and can’t wake me up for food and I didn’t get up to check her and she is unconscious? So why am I sacrificing my mental health for something that is not likely to happen, especially if I see her PMPS number is on the high side? Partly because I am a worrier, about everything, I always assume the worst. The likely outcome is the cat would be just fine if I set up the auto feeder and sleep through the night.

Wise advice from Liz, we should all try to take better care of ourselves, not just our kitties. I am going to try out the auto feeder in the next week and see if I can let myself sleep for one night without setting alarm. Baby steps:)

Take care of yourself and give yourself some time to relax, if just for a day to recharge.
 
Hi @Julie and Honey and @Figaro's Liz ,

I am very sorry you're going through a similar distress, but relieved that I am not alone in it.
I can see that our biggest fear to all of us is the nighttime.

Julie, why don't you try to use the feeder during the day and make sure it works fine? You'll also wake up anyway during the night so you'll be able to see if it opens or not. Once you're certain it woks fine, you'll be (maybe) more at peace?
Figaro's Liz said:
he had a glass of wine and swirled it around. He said: your life feels like this, tossing and tumultuous... but it will settle, like this (as the wine stopped sloshing). Nothing is ever perfectly still, but these tumultuous times DO subside. Things will get better.
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I love this! I can picture it like a scene in a (very good ;) ) film. I really hope things get better and settle. Because right now I do not see any future. I just see anxiety and pain in the years to come.
I had a cat, my first cat, she was my love, Sonia. She was living at my mom's house because she hated to be in an apartment with me. She got sick at 20. I was living in France at the time. I started to nurse her for a week at my mom's place (my mother is blind and cannot keep up with the nursing etc), but weeks became months, and her health kept declining; I stopped working, I stopped sleeping and eating, just like now. The few moments she felt better were a joy and a relief, but it did not last and we had to say good bye to her after 6 months of intense caring. It was an immense pain to let her go, and after that experience I never totally recovered, sleep-wise and mentally. Now that was only 6 months, but what if Macka lives another 5 years, which I hope? I am afraid of losing it completely. You may think I should learn from it, but that's just how I am, I am a worrier and prone to anxiety and do not know how to function differently.
 
Good idea on the feeder.

Sounds like you may be taking the stress around you last kitty’s situation and thinking the same bad thoughts around the new situation and cat. It is understandable, I have been the same way my whole life, worry, worry, worry. People that are always positive and upbeat just don’t get it (and I don’t understand how people can be so positive). Just remember this is a different kitty and he will also feel your stress, try to let him be a source for your calm rather than one of worry. I know it is easier said than done. Take some time to just relax and pet him, taking deep breaths while you do so, close your eyes and just feel his soft fur, he may help you reduce your stress! Hang in there:bighug:
 
I don't want to assume anything about Sonia and the nature of her illness--I'm so sorry, I can truly empathize with how painful that must have been and why it is overshadowing this scary time with Macka. But also remember, as it says at the top of our wonderful website, diabetes is a treatable condition and so many cats (and people!) with diabetes live great lives with proper care.... which YOU are giving, and will continue to give even better as you keep learning.

It's okay to worry and it's good to be vigilant. But as Julie said, breathe! Remind him how much you care for him and that he will be okay (even if you don't feel that yourself, yet). I talk to Figaro all the time and I'll be darned if he doesn't perk up when I tell him he is a pretty kitty :D
 
Penelope, you are just starting the sugar dance, this is the most difficult time! It WILL get easier. You will learn how the insulin works, you will learn how Macka's body works. Don't think ahead just deal with the now and in no time you will be a pro. I was a complete wreck when I started this with my Eleanor, I was convinced I was going to make a mistake and kill my cat. Well, she lived with diabetes, and with me (!) for 7 years and 5 months.
 
Hi Penelope @Penelope and Mačka :)

I know what you mean about this feline diabetes wreaking havoc on one's mental health and on all other aspects of one's life. My partner and I have our own business and I don't think I could have done this if I had to report for work on time every morning or wasn't able to come home to check on Zorro whenever I needed/wanted to. (That said, I'm sure many diabetic cat parents on here are employed and they somehow make it work. Huge hats off to them.)

@Figaro's Liz 's story from her brother is a great analogy for us all to remember! :bighug:

When I'm down and desperate my partner also often reminds me that, for Zorro, everything is actually better than it was before (ie. before we home tested, before we became more informed, etc.) It is just for us that everything feels and appears worse, and that is only because we are now more aware and informed, which leads to feeling overwhelmed at times. Think about it like this: You currently put a lot more thought into the choice of Macka's food, so he is eating better. You are home testing, which shows you how the insulin works in his little body so you can stay on top of things and eventually steer his diabetes in a state of being better regulated. You are spending more time with him and paying him more attention, which he loves. So for Macka, things are as good as they can currently be. However inside your head you are dealing with information overload, exhaustion, fear, what if, what if... All stuff that Macka knows nothing about and that doesn't worry him. When I picture how all my thoughts and fears are just my own and not Zorro's, it makes me feel better about his situation. I think we project a lot of our own feelings onto our kitties.

Yes, Zorro's blood glucose levels are all over the place, as you saw. It really brings me down at times, especially when I record a few consecutive high numbers.
Zorro was diagnosed in August 2017 and his diabetes was very badly managed for 18 months before I decided to become more informed. Our vet had recommended dry food to us so for 18 months that was all that I religiously bought and fed Zorro. I was also discouraged from home testing his bg. I'll send you the link to my introduction post soon then you'll see just how bad Zorro's start with diabetes was. I believe those first 18 months have a lot to do with the struggle I'm having now. You are in a much better position, home testing from the start, feeding better and starting off with Lantus insulin so I think you'll have it easier once you find the right starting dose.
Also note that I've only been following this board's TR protocol since June 26, so it's really just the bottom few entries of the SS that should be looked at. The fact that I've changed my dosing schedule and dose so often before starting this protocol is another factor that has slowed down progress, I think.

About how I feed: I hope I didn't give you wrong advice there so experienced members can comment to help me too. I have never really focused on having Zorro eat right before I dose him, for a few reasons: Zorro eats everything and getting him to eat his meal is never a problem so I'm not afraid that he won't eat after I've dosed him. I use Levemir insulin which has a slower onset (like Lantus) than say, Vetsulin, so Zorro always has a meal at least before onset of the insulin. I shoot at 7:30am and 7:30pm and I feed at 7:30am, 12:30pm, 5:30pm, then his evening meal that would normally give at 10:30pm I now divide between 9:30pm (+2) and 10:30pm (+3). Then another small meal at 2am or 3am.

I used to only feed Zorro FF Classic Salmon Feast which is on the lower end of the carb scale, I believe. I have used it a few times to bring his bg up successfully with only about a 1/2 a can so I don't think it can be fed limitlessly.

Hang in there, we'll get to a better place - hopefully soon! :bighug:
 
Zorro's mom said:
@Julie and Honey I'm relieved to see that I'm not the only one who's bought an automatic feeder but haven't used it yet! :joyful: Somehow getting up and losing sleep just seems simpler. My partner thinks I'm mad :facepalm:
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I am with you on that! I finally took it out of the box after a few weeks, but have yet to put food in it and show it to the cat. It’s just me and the cat, so she thinks I am mad, lol. Crazy mommy with all her pointy things always talking to herself. :joyful:
 
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