Advice please low bg earlier

[Ann & Liz]

Hoping for some advice please - following the curve last week our vet wanted us to increase Caninsulin to 2.5 twice daily. As we feel it is still early and that some readings were improved we requested that we wait a few more days (glad we did). Left Lila for little while this am and returned at lunchtime to find her quite sleepy and bg low. (see SS). We gave her some of her ordinary food and she is safe now. Would you say this could be a remission starting or are we being a bit too optimistic as yet. We wonder if we should discuss a change in insulin to a less harsh one or a reduction rather than increase at this stage. Lila is now on Lilys Kitchen (since yesterday). The previous diet was low carb too. Any advice gratefully received. Lila is definitely a little brighter since treatment begun and was sharpening her claws for the first time in ages yesterday. The vet says we cannot rule out a pancreatic tumour and she also has ckd.

 

[Critter Mom]

Left Lila for little while this am and returned at lunchtime to find her quite sleepy and bg low.

Be very careful of that. Saoirse only had one symptomatic hypo (on Caninsulin) and what you describe here sounds very similar.

There's no way of knowing for certain but because you didn't test till +6 it is possible that:

1. Lila's numbers may have dropped hard and fast at the beginning of the cycle.

2. Lila's numbers may have been uncomfortably low/too low earlier in the cycle.

3. Both.

This could be a reason why she might have been so sleepy (hard on the body).

The food change may be affecting Lila's numbers. Some Lily's Kitchen foods are ultra-low-carb.

Caninsulin typically gets going anywhere from +1.5 onwards. Some cats metabolise insulin faster than others. While some cats may nadir at +4 - +5 on Caninsulin other cats (my own included) may actually nadir at +3 (or even earlier if the dose is too high/remission signs start appearing). Testing at +2 in every cycle possible can give advance warning of where it's headed and whether extra monitoring / intervention may be needed during the cycle. If at all possible I'd recommend whenever possible closely monitoring Lila for the first few hours of every cycle and do a BG test at +3 at the very latest until you get a better idea of how early she nadirs. And always do a before bed BG check.

Great job on the testing and very good call on the conservative approach to treatment.

There is no way of actually knowing whether Lila's numbers may have dipped below the hypo threshold earlier in the cycle. All I can offer is my own experience here. When Saoirse exhibited clinical signs and BG values similar to Lila's she became MUCH more sensitive to insulin immediately after it. If Lila were mine I would be inclined to reduce the dose this evening and plan to monitor for a good part of tonight's PM cycle for safety. Other members may have a different view. Note that her preshot test might go higher than normal if she 'bounces' off the low number today. A higher preshot is NO GUARANTEE that the dose she got on this AM cycle will be OK for her tonight: Caninsulin can tank numbers even from a very high preshot.

Another thing; even with the feeding (LC) she got the food fairly late in this cycle and numbers didn't climb very much after the food. The crystalline fraction of Caninsulin can provide a little bit of extension of BG lowering effect around the +7 - +10 period (not as strong an action as the amorphous fraction which tends to drop numbers quite hard and fast in the early hours of the cycle). If you can get tests at +10, +11 and PMPS you'll get a better picture of how her BG levels are trending before giving the next dose.

Does your vet have an out of hours number? I'd recommend giving them a ring to keep them in the loop. Be sure to mention the food change.

My final suggestion is to work with your cat's data and clinical signs. Certainly take into consideration what your vet may advise you (and maybe any useful input you may get from experienced members here) but always look at the whole picture; you're the one holding the syringe. In fairness to your vet at least only a 0.5IU dose increase was suggested. Was the curve run at home or in the vet's office? If at the vets then the curve data may have been influenced by vet stress.

Saoirse had only the one symptomatic hypo very early in her treatment when I didn't have much experience or confidence in how to treat her with insulin (Caninsulin at that time). I rang the vet one afternoon because I wanted to reduce her dose based on her data (and she was going through the food transition at the time). The vet insisted I keep her at the dose she was on. I didn't feel comfortable with this advice (ran counter to everything I had learned here and at catinfo.org) but I was too much of a wuss to go against the vet. That dose caused the hypo. Thankfully I did Saoirse's normal PM+3 before bed BG test. FDMB, Dr Lisa Pierson and that BG test saved my girl's life that night (and it was the last time I chose to blindly follow dosing advice from a vet not well-versed in FD).

In fairness to your vet at least only a 0.5IU dose increase was suggested. (More often than not we see vets increasing doses too fast and too steeply.) Was the curve run at home or in the vet's office? If at the vets then the curve data may have been influenced by vet stress.

If you're not already testing for ketones then I strongly recommend you grab some test strips (e.g. Bayer Multistix, Keto-diastix) and test for ketones daily. Ketones are another thing that can cause lethargy. If you get a positive test for ketones you need to call your vet straight away for advice.

(Sorry this post is a bit rambly; I'm not feeling very well and can't edit myself.)



Mogs
.

 

[Ann & Liz]

Be very careful of that. Saoirse only had one symptomatic hypo (on Caninsulin) and what you describe here sounds very similar.

There's no way of knowing for certain but because you didn't test till +6 it is possible that:

1. Lila's numbers may have dropped hard and fast at the beginning of the cycle.

2. Lila's numbers may have been uncomfortably low/too low earlier in the cycle.

3. Both.

This could be a reason why she might have been so sleepy (hard on the body).

The food change may be affecting Lila's numbers. Some Lily's Kitchen foods are ultra-low-carb.

Caninsulin typically gets going anywhere from +1.5 onwards. Some cats metabolise insulin faster than others. While some cats may nadir at +4 - +5 on Caninsulin other cats (my own included) may actually nadir at +3 (or even earlier if the dose is too high/remission signs start appearing). Testing at +2 in every cycle possible can give advance warning of where it's headed and whether extra monitoring / intervention may be needed during the cycle. If at all possible I'd recommend whenever possible closely monitoring Lila for the first few hours of every cycle and do a BG test at +3 at the very latest until you get a better idea of how early she nadirs. And always do a before bed BG check.

Great job on the testing and very good call on the conservative approach to treatment.

There is no way of actually knowing whether Lila's numbers may have dipped below the hypo threshold earlier in the cycle. All I can offer is my own experience here. When Saoirse exhibited clinical signs and BG values similar to Lila's she became MUCH more sensitive to insulin immediately after it. If Lila were mine I would be inclined to reduce the dose this evening and plan to monitor for a good part of tonight's PM cycle for safety. Other members may have a different view. Note that her preshot test might go higher than normal if she 'bounces' off the low number today. A higher preshot is NO GUARANTEE that the dose she got on this AM cycle will be OK for her tonight: Caninsulin can tank numbers even from a very high preshot.

Another thing; even with the feeding (LC) she got the food fairly late in this cycle and numbers didn't climb very much after the food. The crystalline fraction of Caninsulin can provide a little bit of extension of BG lowering effect around the +7 - +10 period (not as strong an action as the amorphous fraction which tends to drop numbers quite hard and fast in the early hours of the cycle). If you can get tests at +10, +11 and PMPS you'll get a better picture of how her BG levels are trending before giving the next dose.

Does your vet have an out of hours number? I'd recommend giving them a ring to keep them in the loop. Be sure to mention the food change.

My final suggestion is to work with your cat's data and clinical signs. Certainly take into consideration what your vet may advise you (and maybe any useful input you may get from experienced members here) but always look at the whole picture; you're the one holding the syringe. In fairness to your vet at least only a 0.5IU dose increase was suggested. Was the curve run at home or in the vet's office? If at the vets then the curve data may have been influenced by vet stress.

Saoirse had only the one symptomatic hypo very early in her treatment when I didn't have much experience or confidence in how to treat her with insulin (Caninsulin at that time). I rang the vet one afternoon because I wanted to reduce her dose based on her data (and she was going through the food transition at the time). The vet insisted I keep her at the dose she was on. I didn't feel comfortable with this advice (ran counter to everything I had learned here and at catinfo.org) but I was too much of a wuss to go against the vet. That dose caused the hypo. Thankfully I did Saoirse's normal PM+3 before bed BG test. FDMB, Dr Lisa Pierson and that BG test saved my girl's life that night (and it was the last time I chose to blindly follow dosing advice from a vet not well-versed in FD).

In fairness to your vet at least only a 0.5IU dose increase was suggested. (More often than not we see vets increasing doses too fast and too steeply.) Was the curve run at home or in the vet's office? If at the vets then the curve data may have been influenced by vet stress.

If you're not already testing for ketones then I strongly recommend you grab some test strips (e.g. Bayer Multistix, Keto-diastix) and test for ketones daily. Ketones are another thing that can cause lethargy. If you get a positive test for ketones you need to call your vet straight away for advice.

(Sorry this post is a bit rambly; I'm not feeling very well and can't edit myself.)



Mogs
.

Thank you for your reply Mogs. By using the carb calculator the food she was on (applaws) appeared to be nil carbs.

Be very careful of that. Saoirse only had one symptomatic hypo (on Caninsulin) and what you describe here sounds very similar.

There's no way of knowing for certain but because you didn't test till +6 it is possible that:

1. Lila's numbers may have dropped hard and fast at the beginning of the cycle.

2. Lila's numbers may have been uncomfortably low/too low earlier in the cycle.

3. Both.

This could be a reason why she might have been so sleepy (hard on the body).

The food change may be affecting Lila's numbers. Some Lily's Kitchen foods are ultra-low-carb.

Caninsulin typically gets going anywhere from +1.5 onwards. Some cats metabolise insulin faster than others. While some cats may nadir at +4 - +5 on Caninsulin other cats (my own included) may actually nadir at +3 (or even earlier if the dose is too high/remission signs start appearing). Testing at +2 in every cycle possible can give advance warning of where it's headed and whether extra monitoring / intervention may be needed during the cycle. If at all possible I'd recommend whenever possible closely monitoring Lila for the first few hours of every cycle and do a BG test at +3 at the very latest until you get a better idea of how early she nadirs. And always do a before bed BG check.

Great job on the testing and very good call on the conservative approach to treatment.

There is no way of actually knowing whether Lila's numbers may have dipped below the hypo threshold earlier in the cycle. All I can offer is my own experience here. When Saoirse exhibited clinical signs and BG values similar to Lila's she became MUCH more sensitive to insulin immediately after it. If Lila were mine I would be inclined to reduce the dose this evening and plan to monitor for a good part of tonight's PM cycle for safety. Other members may have a different view. Note that her preshot test might go higher than normal if she 'bounces' off the low number today. A higher preshot is NO GUARANTEE that the dose she got on this AM cycle will be OK for her tonight: Caninsulin can tank numbers even from a very high preshot.

Another thing; even with the feeding (LC) she got the food fairly late in this cycle and numbers didn't climb very much after the food. The crystalline fraction of Caninsulin can provide a little bit of extension of BG lowering effect around the +7 - +10 period (not as strong an action as the amorphous fraction which tends to drop numbers quite hard and fast in the early hours of the cycle). If you can get tests at +10, +11 and PMPS you'll get a better picture of how her BG levels are trending before giving the next dose.

Does your vet have an out of hours number? I'd recommend giving them a ring to keep them in the loop. Be sure to mention the food change.

My final suggestion is to work with your cat's data and clinical signs. Certainly take into consideration what your vet may advise you (and maybe any useful input you may get from experienced members here) but always look at the whole picture; you're the one holding the syringe. In fairness to your vet at least only a 0.5IU dose increase was suggested. Was the curve run at home or in the vet's office? If at the vets then the curve data may have been influenced by vet stress.

Saoirse had only the one symptomatic hypo very early in her treatment when I didn't have much experience or confidence in how to treat her with insulin (Caninsulin at that time). I rang the vet one afternoon because I wanted to reduce her dose based on her data (and she was going through the food transition at the time). The vet insisted I keep her at the dose she was on. I didn't feel comfortable with this advice (ran counter to everything I had learned here and at catinfo.org) but I was too much of a wuss to go against the vet. That dose caused the hypo. Thankfully I did Saoirse's normal PM+3 before bed BG test. FDMB, Dr Lisa Pierson and that BG test saved my girl's life that night (and it was the last time I chose to blindly follow dosing advice from a vet not well-versed in FD).

In fairness to your vet at least only a 0.5IU dose increase was suggested. (More often than not we see vets increasing doses too fast and too steeply.) Was the curve run at home or in the vet's office? If at the vets then the curve data may have been influenced by vet stress.

If you're not already testing for ketones then I strongly recommend you grab some test strips (e.g. Bayer Multistix, Keto-diastix) and test for ketones daily. Ketones are another thing that can cause lethargy. If you get a positive test for ketones you need to call your vet straight away for advice.

(Sorry this post is a bit rambly; I'm not feeling very well and can't edit myself.)



Mogs
.

Thank you so much, Mogs, for your reply. Yes we are checking by phone with vet before next shot she had already said to reduce to 1.5 for tonight to be safe but will review when we phone in again. It seems ( if carb calculator is correct) that the food she was on was 0% and lily's kitchen chicken is 5.9% so we were presuming that we were actually increasing carbs as felt the previous food was too low. Just tested again and she is 14.1 now. Will be very vigilant. And intend to get a urine sample into vets tomorrow too for ketones. Vet didn't seem keen on us home testing those! Hope you feel a little better soo and thank you.

 

[Critter Mom]

It seems ( if carb calculator is correct) that the food she was on was 0% and lily's kitchen chicken is 5.9% so we were presuming that we were actually increasing carbs as felt the previous food was too low.

Now there's another sugar cat conundrum; we've found here that some kitties may do better on a moderately low-carb food compared to an ultra-low-carb food while others may be extremely carb sensitive and only the lowest carb foods will suit them. Indeed, some kitties' BG may spike if you feed them a particular protein (beef may often be a culprit, as may products containing soy or ingredients of 'vegetable origin' - typically also soy). As you gather more data you'll learn more about how different foods affect Lila's BG. It's always a good idea to do a bit of closer monitoring when you're trialling a new food (especially in the early days).

Tricky things, kitties; they don't pay much attention to the "How to Be a Textbook Feline Diabetic" manual. Regular monitoring will help you not just with keeping Lila safe with her insulin dosing, it can help you learn a great deal about what suits her little body best.

And intend to get a urine sample into vets tomorrow too for ketones. Vet didn't seem keen on us home testing those!

It should be a normal, regular part of monitoring for all diabetics. In my time here it appears to me that ketosis/DKA are very much treated as poor relations when it comes to the information vets give out to feline diabetic caregivers about potential complications of the disease - but keeping a cat clear of ketones is every bit as important as keeping their BG in a safe, healthier range.

You can get Bayer Multistix 10SG strips fairly reasonably on ebay (and maybe Amazon UK) - certainly cheaper than local pharmacies. If you put a bit of clingfilm on top of Lila's 'favourite spot' in her litter box it should collect enough of a pee sample for testing.


Mogs
.

 

[Ann & Liz]

Now there's another sugar cat conundrum; we've found here that some kitties may do better on a moderately low-carb food compared to an ultra-low-carb food while others may be extremely carb sensitive and only the lowest carb foods will suit them. Indeed, some kitties' BG may spike if you feed them a particular protein (beef may often be a culprit, as may products containing soy or ingredients of 'vegetable origin' - typically also soy). As you gather more data you'll learn more about how different foods affect Lila's BG. It's always a good idea to do a bit of closer monitoring when you're trialling a new food (especially in the early days).

Tricky things, kitties; they don't pay much attention to the "How to Be a Textbook Feline Diabetic" manual. Regular monitoring will help you not just with keeping Lila safe with her insulin dosing, it can help you learn a great deal about what suits her little body best.


It should be a normal, regular part of monitoring for all diabetics. In my time here it appears to me that ketosis/DKA are very much treated as poor relations when it comes to the information vets give out to feline diabetic caregivers about potential complications of the disease - but keeping a cat clear of ketones is every bit as important as keeping their BG in a safe, healthier range.

You can get Bayer Multistix 10SG strips fairly reasonably on ebay (and maybe Amazon UK) - certainly cheaper than local pharmacies. If you put a bit of clingfilm on top of Lila's 'favourite spot' in her litter box it should collect enough of a pee sample for testing.


Mogs
.

Thank you, will keep a very close eye on everything. Also should have said curve was done at home.