911!! Barry’s BG is 32

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barrybuttonsmom

barrybuttonsmom

Member Since 2020
Help!

First and foremost, Barry’s BG is 32 right now.

He had a dental cleaning with extractions on 12/30. He has had a semi-difficult time with recovery. I took him to an internist on 1/6 who believes Barry does have acromegaly (even with mildly elevated numbers) and would respond best to Glargine rather than Prozinc. We have not made the switch yet because for the last six days, he has vomited 1-2x/day. Myself and the doctors have dismissed it as nausea from clindamycin or pain meds. We stopped clindamycin and metacam a couple days ago.

He vomited while I was at work yesterday (between 8a and 12p). I checked his BG at 1:20p and it was 317. Well, today he vomited at 11:15a. I decided I was done listening to his doctor and was going to trust my gut instead. Took him into the vet and ran full bloodwork, fructosamine, and x-rays. All were normal, minus K and glucose. Potassium was only slightly low and glucose was 32. They gave him 175mL fluids because he was very dehydrated and 3cc of 50% dextrose solution.

I now have my own alphatrak so I now know my at home readings are accurate.

But for now — what should I do? Do I skip insulin tonight? Keep giving dextrose? Or should I take him to MedVet where he can be kept for observation? This is our first hypo crisis (that I have known about). I am really freaking out here. He’s supposed to be on 4u prozinc
 
barrybuttonsmom said:
Help!
First and foremost, Barry’s BG is 32 right now.
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During treatment for hypoglycemia, try to test every 15 - 20 minutes until you see the bgs begin to rise. Then continue to test until you are satisfied that the cat is out of danger.

VERY LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a very low number (under 40 mg/dL or 1.9 – 2.2 mmol/L) administer a teaspoon of corn syrup, liquid glucose, pancake syrup or honey, or INSTA-GLUCOSE and follow with food until the blood glucose numbers rise to acceptable levels. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If using liquid glucose, dilute with water for a thinner consistency.

How to treat HYPOS - THEY CAN KILL! Print this Out!!

I'll try to tag some folks to help....
 
At the moment, let's get you past the low reading, we can look at dose later. Give either karo syrup or honey immediately on the gums and test in 20 minutes. That is way too low in an alphatak, he needs to get his BG levels up now. Any symptoms of hypo? Ie, staggering, disorientation?
 
I'm here. It's been 20 min since your last reading. Please take another and let us know what it is. Did you give syrup /honey?? Did you feed high carb food?? This is an extremely low and life threatening number on an Alphatrak. I would suggest giving him a lot of syrup and bringing him straight to an er.


Your dose is very high and clearly too high. Going forward I might bring that dose down to 2 units and see what the numbers do for a few days.
 
Christie & Maverick said:
At the moment, let's get you past the low reading, we can look at dose later. Give either karo syrup or honey immediately on the gums and test in 20 minutes. That is way too low in an alphatak, he needs to get his BG levels up now. Any symptoms of hypo? Ie, staggering, disorientation?
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I’m sorry. I am horrible at using this forum. Not very tech savvy. I have not been doing reading before his insulin for the past couple days after finding out my reader was inaccurate. AlphaTrak said 300something when my human said high and with ketones. So, we ordered an alpha trak for myself yesterday. I just took home a boxed alpha trak from my work (the vet). He had a BG of 32 at the vet. We just got home. 45 min drive... going to check now. He is having symptoms. Disoriented, meowing urgently, and twitching on his back. However, he has a history of non-glucose related neurological episodes so I wasn’t too alarmed at first. I feel like the worlds worst owner right now for not checking him over the last couple days and not getting him seen sooner.
 
Oh I think I understand, you had him with you at work? Please do try and get another test of you can, and if the numbers aren't much better, or you aren't sure if you can manage at home (you'll need to keep testing and intervening with high carb food and/or syrup), you may need to take him in to be put on a drip and be monitored more closely.
 
Christie & Maverick said:
Oh I think I understand, you had him with you at work? Please do try and get another test of you can, and if the numbers aren't much better, or you aren't sure if you can manage at home (you'll need to keep testing and intervening with high carb food and/or syrup), you may need to take him in to be put on a drip and be monitored more closely.
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He is at 98 right now. I work at a vet clinic. I was off today and had one do the docs come in to see him before going to ER
 
I should add, if the 32 was the glucose reading from the blood tests that you ran vs. AT2 from capillary blood that's really low. Hope the dextrose solution helped.
 
barrybuttonsmom said:
He is at 98 right now. I work at a vet clinic. I was off today and had one do the docs come in to see him before going to ER
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Oh good, that's much better, how is he acting now? Will he eat a little food? Where is that number relative to when you gave his insulin this morning? Ie. how many hours after dose?

Normally when people intervene with high carb or syrup, we suggest you continue to monitor as the HC and syrups can wear off quickly, and the numbers can bobble around a little. Not sure about dextrose solution. I'd get another test in 1 hour if you can, just to be sure his BG level is still staying up.
 
Christie & Maverick said:
Oh good, that's much better, how is he acting now? Will he eat a little food? Where is that number relative to when you gave his insulin this morning? Ie. how many hours after dose?
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He is hiding in my closet right now. Walking around much better though. Doesn’t seem as disoriented. He ate some FF for me when we got home. I did not test pre-shot this morning. Gave 4u at 6:45am. He ate great this morning though. Vomited around 11:15. Rushed to work and that’s when we got 32 BG from capillary.
 
Sho
Christie & Maverick said:
Oh good, that's much better, how is he acting now? Will he eat a little food? Where is that number relative to when you gave his insulin this morning? Ie. how many hours after dose?

Normally when people intervene with high carb or syrup, we suggest you continue to monitor as the HC and syrups can wear off quickly, and the numbers can bobble around a little. Not sure about dextrose solution. I'd get another test in 1 hour if you can, just to be sure his BG level is still staying up.
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I was advised to give him some dextrose solution 50% every couple hours til this evening and skip insulin tonight.
 
Ok thanks for the clarification, I'm glad he is feeling better, other than hiding in the closet :). Mine get put out with me after being taken to the vet too. I'm not a Prozinc user, so I can't offer advice on dose, other than to say 4u is too much. Very scary to get so low, and symptomatic. He will be likely sensitive to insulin, after having a symptomatic hypo, so I'd be cautious with monitoring and dosing over the next few days, I have used both Lantus and Levemir, and even with those insulins, it is important for me to be able to see some previous test info before I offer suggestions on dose, so if you are able to set up a spreadsheet going forward, that will help people help you.

https://felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
JanetNJ said:
I'm here. It's been 20 min since your last reading. Please take another and let us know what it is. Did you give syrup /honey?? Did you feed high carb food?? This is an extremely low and life threatening number on an Alphatrak. I would suggest giving him a lot of syrup and bringing him straight to an er.


Your dose is very high and clearly too high. Going forward I might bring that dose down to 2 units and see what the numbers do for a few days.
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He is at 98 now after giving 3cc dex 50% soln
 
Christie & Maverick said:
Ok thanks for the clarification, I'm glad he is feeling better, other than hiding in the closet :). Mine get put out with me after being taken to the vet too. I'm not a Prozinc user, so I can't offer advice on dose, other than to say 4u is too much. Very scary to get so low, and symptomatic. He will be likely sensitive to insulin, after having a symptomatic hypo, so I'd be cautious with monitoring and dosing over the next few days, I have used both Lantus and Levemir, and even with those insulins, it is important for me to be able to see some previous test info before I offer suggestions on dose, so if you are able to set up a spreadsheet going forward, that will help people help you.

https://felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
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I gave 0.5cc dextrose at 3:40. BG is 119 right now at 4:52. Should I keep giving sugar?
 
By my count that's about+10 after insulin today. Since you are skipping tonight, I don't think additional dextrose is needed, but I'd continue with normal feeding, and check BG in another couple of hours. He may end up having a wicked bounce from getting down to 32 earlier, so don't be surprised if his numbers are higher tomorrow since you are skipping also.

ETA: if when you test in another couple of hours his BG levels go back down, perhaps in the 90s, I'd give some more dextrose then. As I said, I'm not sure how long the dextrose affects the blood sugars levels so I'd be more comfortable suggesting to watch for the numbers to continue to stay up. From my understanding Prozinc tends to be more of an in and out insulin but it is possible for one cycle to affect the next.

https://www.felinediabetes.com/FDMB...-the-prozinc-basics-please-start-here.164995/
 
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Hi Emily, I was just checking in to see how Barry was doing. Now that (I hope) the dust has settled, please do continue to post if or when you need help going forward, there are many of us happy to help if you have any questions, and even if I don't personally have the answers, I'm always happy to try and steer you in the right direction :)

Many of us were quite worried for you and Barry after seeing that 32 on AT2, and not having an update for quite a while. I feared the worst, but am so glad Barry is fine.
 
Also according to how we dose here, he earned a reduction. You should lower his dose to 3.75 or 3.5 moving forward. What happened today is him telling you 4 units is too high a dose right now.
 
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Christie & Maverick said:
Hi Emily, I was just checking in to see how Barry was doing. Now that (I hope) the dust has settled, please do continue to post if or when you need help going forward, there are many of us happy to help if you have any questions, and even if I don't personally have the answers, I'm always happy to try and steer you in the right direction :)

Many of us were quite worried for you and Barry after seeing that 32 on AT2, and not having an update for quite a while. I feared the worst, but am so glad Barry is fine.
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Unfortunately, we are not doing better. His BG is at 657 right now. Just gave 2u prozinc. Checking BG again in 20.
 
I'm sorry, I guess the wicked bounce I suspected might happen has happened. His numbers will come down, I know seeing that high number is not fun. Testing in 20 minutes won't tell you much, it will take some time for the insulin to kick in. He may stay in higher numbers for up to 6 cycles until the bounce resolves.

Bouncing - is simply a 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 BG in the 200s, 300s or higher for a long time, then even a BG to 150 can trigger a "bounce". Bouncing can also be triggered if the BG 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. *Usually* bounces clear within 3days (6 cycles).
 
Christie & Maverick said:
I'm sorry, I guess the wicked bounce I suspected might happen has happened. His numbers will come down, I know seeing that high number is not fun. Testing in 20 minutes won't tell you much, it will take some time for the insulin to kick in. He may stay in higher numbers for up to 6 cycles until the bounce resolves.

Bouncing - is simply a 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 BG in the 200s, 300s or higher for a long time, then even a BG to 150 can trigger a "bounce". Bouncing can also be triggered if the BG 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. *Usually* bounces clear within 3days (6 cycles).
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Thank you so much for your help. I really appreciate it. It’s weird how I absolutely can not think rational or use any of my education when it comes to him. I worry so darn much. His internist had suggested we switch to Glargine. Should we do the switch ASAP to give him a better insulin option or wait until he stabilizes again?
 
You're welcome :). Feline diabetes is a learning curve, regardless of what your background is, don't be too hardness on yourself. Now that you see how important testing is, I think the process will be less worrisome. As for the switch to Lantus, it is a bit tricky, since ideally you would take into consideration the current working dose of Prozinc, when deciding what the starting dose of Lantus should be, but we don't really have that available. We just know 4u of Prozinc at the moment is too high. I saw in a previous post that you mentioned Barry's numbers were stuck pretty high on 3.5u and he was positive for acromegaly.

Perhaps others will chime in, but I'd let this episode settle a couple of days, keep getting some tests in, then if you are ready to switch to Lantus we can see what might be a good starting dose, based on those additional tests.
 
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