https://www.felinediabetes.com/FDMB/threads/angels-near-hypo.279959/ What on Earth is going on? This is the 3rd low in a week, and the lowest one so far. I'm dealing with the lower numbers, however. I'd like to know: 1. How much should I reduce her with the next shot (I suspect I'll have to skip the AM shot again, but after that when her preshot levels are okay again)? 0.25 again, or maybe more? 2. Her current vial of prozinc is nearly empty, so I'll have to start another soon. I've read in the stickies that new vials of insulin are more potent at first; should I reduce preemtively when I draw from the new vial (somewhere in the next few days I think)?
When you do give her insulin again, please reduce her dose by a full half unit. And by all means please keep testing during the mid cycle.
I see she’s up to 67. Give her a spoonful of low carb food and test again in 20-30 minutes. You must make sure she doesn’t drop back down. The rule is to keep testing for 2 hours after anything high carb is given. If she’s dropping back down then you will have to use higher carb.
Hi, I kept the spreadsheet up to date. 2.1 was the lowest she went, the honey kicked in quickly- she's at 4.6 now. But I'll keep monitoring her in case she goes back down. She gets a snack after every test and I have everything from the hypo kit on standby.
Okay. You are not around and I have to go. I have I have been checking her spreadsheet and I see that you have gotten more tests and she has gone up more. I have a few questions for you. I would like to know what she ate. I don’t need to know the names of the foods just was it low carb medium carb, high carb and what time in the cycle she ate. I feel like a broken record, but it’s very important for her to have snacks in the early part of the cycle possibly throughout the evening a lot of people use timed automatic feeders for this purpose. She needed to get a test long before the test that she had in tonight cycle, which was way too late and she was already in the lime green. She should’ve had a plus to test to see if she had dropped from the preshot test. If she’s about the same at +2 that’s good , if she’s dropped a lot you need to intervene at that point in time at the very latest I would recommend a +3 test on Angel before you go to bed. If she is dropping a lot then you will need to set alarms to wake up to test her in the nighttime cycle. I am sure I have some more questions but this kind of sums up what I’m seeing when I look at her spreadsheet, please read through my other comments above this one I have to run out really fast I’m going to be late as it is for my evening appointment and I have to go, but I will check in later in a couple of hours. I’m glad to see that she is doing better now.
Oh, and I am sorry if the message above is garbled or doesn’t have any stops or punctuation in it. I am text talking on my phone right now, which is some thing I hate doing, but I am in a huge hurry, but I will check in in a couple of hours after I get back home.
She is freefed dry high carb. I know it's not great, but I've tried every low carb dry available in my region and they all gave her horrific diarrhea (and I mix the new food in verryyy slowly). She has a very sensitive tummy and only does well on her current food (Royal Canin Digestive Care, ~27% carb). I've tried many wet low carbs too, and ditto with the diarrhea if she gets more than 1 small can a day. Even tried the veterinary diabetes diets, which I know aren't great either with higher carbs, but I figured they'd be better than regular food. No dice either, diarrhea once again. Usually she also gets half a can of wet food (often low carb, but sometimes high) a day, but I've stopped that since her latest bout of diarrhea to give her stomach time to settle. She eats at least once every hour from what I can see when I'm awake. Whenever she gets a snack, she'll always grab a bite of dry afterwards as well. So she has frequent small meals even in the early part of the cycle. During her shots she gets a bit of liquid snack (also high carb). Whenever I test her, she also gets a treat; sometimes liquid snack, sometimes something else. I know, and I'm kicking myself for it. I'd planned to get a +5 but she was frolicking in the garden and looking really happy, so I didn't want to disturb her. I didn't think she's be so very low. Her poor ears are really sensitive from all these tests, and she's so done with me atm. But I will do what needs to be done. During the AM cycle, with the +3 drop, I did set an alarm to get up (I shoot at 2am and 2pm due to my shift work sleep schedule). But she'd gone back up again, which reassured me. Didn't expect this huge drop, though I notice she's often lower during the PM cycle so I'll have to pay extra attention then. No problem, ask anything that comes to mind. Thank you very much for responding here even when strapped for time! PS: do you have any advice for her sore ears?
I don't mind at all! Just glad to read your reply. I will be awake for at least another 3 hours, after that I might go to sleep IF her tests are looking good. Will keep her spreadsheet up to date, I expect I'll have to skip the next shot anyways unless she skyrockets soon.
Hmm, 9.9 at preshot time. Unsure of whether I'll skip or shoot a reduced dose. I think I'll wait for a bit at first and then retest, see if she'll go higher.
1.5 hours later and she's at 8.9. So, I'll be skipping the shot. Going to bed soon but I'll check back for comments when I wake up. Edit: 8.6 I misremembered.
I think it was okay to have skipped that shot for now - especially after the lime green numbers last cycle.
12.6 at preshot. Gave 3.5U. Planning to do a +3 test, and then either a +5 or +6, and then we'll she how it goes further. I can monitor for the entire cycle.
Another question: some fur was shaved off for the first libre back in April, the fur there has not grown back. She had an ultrasound done in May, the fur there hasn't grown back either. We assume it's due to the diabetes, but is there anything we could do to help it grow again? Vet has no tips, says we'll have to wait and see if it'll grow back once she's regulated. I've noticed a few tiny patchy wisps of fur there recently, but no real growth. I found this old thread: https://felinediabetes.com/FDMB/threads/slow-no-fur-growth-diabetes-related.157134/ where someone recommends B-complex supplement/Zobaline. Zobaline isn't available in my region, but other methylcobalamin pills are. Do you think this would help?
I think she should be okay. It is hard to tell when her nadir is, though, because we don't have a lot of data on that which is recent. Yesterday, she went lowest in the +7/+8 time frame. If she's eating/snacking, then she should be okay, I think. What do you think?
Have you had any lab work done on her lately? I assume you did back in April when she was diagnosed. It could definitely be the diabetes. And giving either a B-Complex supplement and/or some Zobaline could possibly help. It would be worth a try. I have given several of my cats Jarrow B-Right B-complex in capsules (dividing one human capsule into ten #4 size capsules). It doesn't have to be Zobaline if you want to try supplementing methylcobalamin. It can just be methylcobalamin. Perhaps it would help her neuropathy even though it pre-dates her diabetes diagnosis and seems unrelated.
Since yesterday, I've been thinking about why she's sometimes doing these dives into lime green. I think it's the high carb food. I know that you've been trying other foods with her, so I understand. And boy do I understand about cats with diarrhea (unfortunately) so I know that, for now, you are doing the best that you can -- and she needs to eat. The frequent eating of the high carb food puts her in a situation where it keeps her BG pretty high. The insulin is working to try to lower the BG. So if she's away from her food for a while (like outside playing, sleeping, etc.) or for any other reason just not eating for a while, that puts her in a position where she can drop quite low. You would have to tell me if you think that may be what has happened in the past. So with her eating the HC food, you may have to find a dose that will lower her BG somewhat, but not into what we would consider "optimal" levels, due to the fact that she could drop too low if she stops eating (especially if you are not around to monitor her.) And you can keep trying to see if there's any lower carb food that she can tolerate without getting diarrhea -- even a bit lower or a medium carb type food -- and anything under ten percent is still considered low carb, remember. It's really rough, I know.
Yeah, I think she won't go much lower now. And I think she'd appreciate the break Yeah, I think so too.
Not since April, no. I think I'll try the methylcobalamin, it would be great if it incidentally also helps with her neuropathy.
I guess that's possible, I don't recall exactly when she ate over the last few days, though I'll keep an eye out and try to write down her eating moments tomorrow to see if there's a connection. And I'll keep looking for a new lower carb food. Do you think it's possible that she's starting to produce her own insulin again? Looking at the past few days, she's much lower than normal even after a skipped shot. Like on the 30th she was 8.6 at PMPS even though it had been 24 hours since her last insulin shot. And today same at 12.6, also lower than normal and 24 hours since last shot. I've also noticed that she's not bouncing much or at all anymore, even after those lime greens from last night she hasn't even hit a pink.
I honestly do think that she is making progress. I’m very happy to see it! That’s all the more reason why you must keep a close watch on her. Cats can be very surprising at these times.
Interesting! Edit: I shoot at 2AM and 2PM, so all the lows have been in daytime cycle! The PM shot is at 14:00 hours, PM+6 till +8 is from 20:00 to 22:00 hours.
I think I'll just give a token dose of 1U. Don't really want another hypo and I'm not sure I can monitor her all night (feeling like absolute crap, I fear I might sleep through any alarms I'll set).
Not sure tbh. I think it's a good sign that she's still in the yellows even with only 1U, but no noticable nadir last cycle. Still, 12.6 is a great preshot level right? Do you think I could start with a +5 test today?
If I were trying to not do too many tests, I would get a +3 and a +5. The plus 3 should tell you if it will be an active cycle. By that time the PZ should have kicked in and be reducing her BG.
Alright, I just did the +3, she's at 10.4 now. So she went down. Does that mean an active cycle? Yesterday she was higher at +3 than preshot, and she had a blue nadir.
What do you think of my AMPS plan for in a couple hours? If <9, skip. If 9-12, shoot 1U. If >12, shoot full dose.
Welp, 4.7 at preshot time so that's another skip! Crazy cat, she never ceases to surprise me. That's 5 skips and 2 delays in a little over a week. This also means she's earned yet another reduction for tomorrow, right?
Yes. Since she dropped below 90, according to SLGS, she should receive another reduction of .25 units. New dose going forward is 3.25 units.
Great! thanks for all your help, this has been pretty stressful/scary and it's nice to know that there's someone helping us along. Shot 3.25 today, she was 16.4 at PMPS. Little higher than it's been the last few days, but still yellow.
At least she stayed yellow after the skipped shot the previous cycle. Perhaps a very small token dose would have been okay. Gradually, as you have more data, you will be able to lower the pre-shot number where you know it's okay to shoot the full dose. Remember, you're not really shooting the AMPS or PMPS numbers, but you are shooting where she will be at her onset time. So for a lot of cats that's +2 with ProZinc. With Angel, she tends to onset later. That's another good reason to have data for the +3.
Yeah, I think with time it'll be easier to know what to do and how she'll respond. Though shooting that low sounds terrifying to me. Mostly because with some of the skipped shots she barely went up at all. She was at 12.3 for AMPS, so I shot full dose. We'll see how that goes. I just read the doc about how the +2 is useful to predict how the cycle will go, I'll aim for a +3 then in her case. Just for my information, would a +2 still be useful data, or not at all because of the late onset?
So, questionable preshot today, but I decided to go for it with full dose. I can monitor the whole cycle, and the similar preshot on the 30th leads me to think that a reduced dose isn't necessary at this preshot value quite yet.
Question: I'm having a harder and harder time with getting blood from her ears recently. In the beginning, she bled a lot. I have the Freestyle Lite Lancet Device, and in the beginning I'd shoot on depth setting 2, and I'd get a nice fat drop, usually right away but always within 3 tries. Now though? We're at depth 4 (as deep as it'll go), I alternate ears, warm her ear beforehand, shoot on the vein, but a lot of the time NOTHING is coming out. When it does bleed, it's only a tiny little bit. In the past few days, it's taken about 10 tries to get a decent sized drop. Obviously this distresses her, and me, and wastes a lot of materials too. Does anyone know what's causing this? Is it scarring from the frequent testing? Is there anything I can do? She used to let me test her easily, but she's starting to hate it now and I can't even blame her. (Also posting this in Feline Health for visibility) Edit: also, I don't know if this matters, but in the beginning I didn't even have to warm her ears. I don't recall if she just always had warm ears or it didn't matter to the testing. But now she pretty much always has cold ears and I always have to warm them up beforehard.
This question specifically aimed at @Suzanne & Darcy Another thing I've been wondering about lately... once her diarrhea fully clears up, I want to start giving her wet again (one meal a day, usually in the evening so around PM nadir). Just for general wellness and happiness and moisture content, in addition to her freefed dry, not replacing it. I still have lots of low carb (and also plenty of high carb) wet food. But I've been thinking about your theory about how it's possible that the high carb food takes her high and then, when she doesn't eat for a few hours, makes her dive. Wouldn't this also be the case if I give low carb wet? She'll absolutely stuff herself on wet because she loves it, and then certainly won't eat dry for a couple hours after. Putting her in the same situation. Going up and down like a yo-yo. If so, should I not give her low carb wet? Maybe add a bit of high carb treat? Or maybe experiment to see if the theory proves true? I'd love to hear your thoughts on this.
Hi! Low carb wet food won't spike her blood glucose like the high carb food does (either wet or dry). Low carb food keeps them on a more even keel with regard to their BG overall -- some cats get a small food bump which goes away after an hour or so, some cats will get no measurable impact on BG with low carb at all. Some cats are very carb sensitive and you can measure a difference between when you give them a 3 percent carb and a 7 percent carb food. In some cats, that would not make a difference. It's good to know how carb-sensitive your cat is by testing before and after food (30 minutes after and an hour after). But anyway, the bottom line is that LC food does not have the same impact on her BG as HC food does. Now, having said that, any cat who isn't eating or goes without food for some hours can have their BG drop lower than you want it to at times.
I've been away for a little while. Did you get some good replies over on the feline health forum? Did anyone send the photo of where you really should be trying to poke == outside of that vein (in other words not aiming for the vein itself?) I never did use a lancing device because I was afraid that the noise would scare my cat -- so I just did it free hand and used very tiny lancets -- but in the beginning I did use a slightly larger lancet.
Yes I did! And I didn't get sent the photo, but I found it myself (I assume this: http://www.felinediabetes.com/images/laur_danny_famoussweetspot.jpg is the one you mean?). I feel very foolish because I did aim for the vein itself once it started getting harder to get blood. I've tested in "the sweet spot" a few times now and did get blood a lot easier. Hopefully she'll forget the pain of the vein pricks soon
Yes, but that's the worry isn't it? It's been a while so I'll just quote the bit I'm talking about: If the high carb generally keeps her BG high, but she doesn't get the high carb for a while (away from food like before OR potentially filled up her belly with low carb wet) she can drop low.
And for the regular spreadsheet updates: another AMPS low! 3.9 this time. So a skip today and another reduction tomorrow. Maybe I should do a +8 test as well... I figured we were safe with 6.6 at +6 just like the last few days, but she clearly dropped lower which was unexpected. I don't like the pink from yesterday, but I think that was just because I was so nervous about using a new vial for the very first time, especially at night, that I only shot a token dose when she was already in the yellow. Seems I was right to worry though, seeing how she dropped 16+ mmol/l this cycle on a full dose. I worry a lot about her going too low while I'm asleep and unaware.
This is NOT a dosing advice, as I am inexperienced with ProZinc (we are on Lantus) just an observation, which I'm sure a lot of, more experienced members will perhaps disagree with: Seeing how her PMPSes are often in the same range, and her AMPSes are low/often the lowest - could it be that she'd benefit from a QD dosing instead of a BID? I understand the mechanics of insulin absorption/metabolism, thus why the BID distribution works best for most cats (emphasis is on most). However, I heard it from other owners as well as from vets when talking about the use of ProZinc in particular, that sometimes a once-a-day administration of it is enough, because after all, it all comes down to the individual cat's metabolism. I wonder what pattern would she have shown keeping her at 3.5 IU QD. Whether she would have stayed yellow both PMPSes, in blues throughout each side of a 24hr cycle, that would gradually turn into greens closer to "nadir" which perhaps falls on the 12th hour aka AMPS. Something like this: PMPS +1 +2 [...] +11 AMPS +1 +2 [...] +11 PMPS beginning of cycle ---- nadir ---- end of 24hr cycle I understand she dropped low on that 4 IU in the PM cycle a few days ago, however, I noticed on my cat, that after a delay and/or even the slightest dose increase, his body would panic and his BG would hit nadir sometimes as shockingly early as +2/+3 of the cycle, as opposed to his usual +5/+6/+7. (Hence why the protocols are written the way they are, because their little bodies need time to adjust to a certain dose, to see its full, evenly distributed potential. It is not to say that 4 IU was a good dose. It was definitely too high for her, and the reduction was earned. It is to point out a reoccurring pattern I observed on my own cat, that may be relevant to yours, too.) So if my theory of a 24hr cycle for Angel would be applicable, and if my math is mathing correctly, that +2/+3 nadir "shock drop" after delay/increase would fall right to those times where Angel went low at +7/+8. Does it make any sense? Again, these are just my observations and the inputs I have encountered from vets and other ProZinc users. I may be completely wrong, and I'd urge you to perhaps discuss this with more experienced members and/or your vet. I just wanted to share my thoughts after looking at your spreadsheet, because I know from experience that we can get very accustomed seeing our own sheets day in and day out, that we may overlook certain patterns that perhaps stand out to others.
Sorry I've not responded sooner, I've been feeling a bit sick myself. Still testing though! And making progress.
I'm not sure, I think I'm not experienced enough for this either. I'll discuss it with my vet, and if any members on here want to weigh in, please feel free. Given that she just had another low/hypo on just 3U, I don't think we can/should increase anyways. I am skipping or shooting reduced doses at AM often, and sometimes it's high after that sometimes it's not. I think we'll just keep doing what we've been doing so far; it seems to be working out well. She's earned another reduction down to 2.75 next shot.
Same! She still struggles a lot while testing, which is annoying (especially since I'm freehanding the lancet now) but hopefully she'll ease up a bit soon. Tried to do a +9 just now after the 3.1 +8, but she was absolutely NOT having it.
Anyways, I thought I'd do a +8 today to see how low she'll go. At 3.1, that's too low once again! I'm guessing AMPS will be low again, probably either a skip or a reduced dose. She seemed to do well on the 1.5U I shot last AMPS. And then we'll shoot 2.75U the next time she can have a full dose. Hoping we can achieve the fabled Remission; she certainly seems determined to keep going down and down. Is that even possible while still on high carb food?
3.1 is not too low on a human meter. But 2.6 is. But look at her go, earning all these reductions! BTW some cats do well in lower numbers, not to mention they are great at masking, so sometimes their hypo is asymptomatic. Such a slippery slope. Mine for example doesn't show any signs unless goes below 1.7
Right?! It's too low, but I can't say I'm not pleased about the rate she's earning reductions at. From 4.5U to 2.75U in less than 2 weeks! Can't wait to find out where we'll be 2 weeks from now. The lowest she's ever tested was 2.1, and no signs during that time either. I'd like to never ever find out what it takes for her to become symptomatic.
It's AMPS time and Angel just puked. She was at 14.5 just prior to puking. Should I still shoot if she'll eat soon? I've never been in this situation before so I'm not quite sure what the protocol is.
Can you monitor her throughout the cycle and/or would she eat if you left food out for her? 14.5 is a safe number to shoot. I have been in a similar situation, where he hasn't eaten past AM +7 (was on a brink of unconsciousness) AND puked at PMPS +1 (thank god, at least I knew he was now on the mend, and the meds that caused the O/D was leaving his system). So no food+barf = shot was delayed to PMPS +3 until I could speak to the emergency vet. She advised me to shoot the normal dose. I left food out for him overnight, he did eat some. They're intuitive eaters, they'd dive in the bowl once they feel the BG is dropping rapidly. Mine was fine during the PM cycle. Dropped steep in the following AM cycle though due to lack of consiatent food intake - numbers wise only, he was fine pathologically. If you have similar PS numbers on the same dose, check your data and see how that cycle went. Or if she hasn't eaten still, give her a token perhaps? I don't know if anyone more experienced will see this in time for your shot (you're already at AM +1 I believe?), but since I'm still awake I thought I'd share my experience, for what its worth.
5 minutes after posting she was already yelling at me for treats again, so I think we'll be okay I gave her some and will wait an hour to see if she'll keep it down, and then feed and shoot as planned. She has food freely available.
However, I can't stay up with you if you decide to shoot, I'm catching a flight in a few hours. Therefore I'd say to play it safe and either skip or token her, or if you can stall try and feed and/or wait for another member. I'm so sorry, I should've started with this
Oh thank god, I feel less guilty now! I'm gonna sleep for a couple of hours then. You may even still be awake when I have to get up I'll keep an eye on the thread
No worries, go sleep! I just shot her since it's been an hour and she's acting normal. I'll test her in 2 to 3 hours and then go to bed too if she's not dropped dramatically.
15.6 at 2 and a half hours after the shot. Imma head to bed, seems the puking didn't affect her much.
I saw this with a huge relief when I woke up, but was in too much of a rush to reply sooner, sorry. Hope she kept it up throughout the cycle... or down? The food and the numbers down, but up enough from luminous green.
18.7 at PMPS today :/ hope she'll go down soon. Not gonna worry yet though, it's only been 2 full cycles on this dose yet.
6.3 at AMPS. Decided to shoot a token dose of 0.5U, just to hopefully temper that higher PMPS a bit. Not confident enough yet to shoot a full dose on this number, maybe in the future.
Nice little uptick to 8.0 at +3. Heading to bed now, hoping to see a yellow/blue PMPS. Should I make a new thread soon btw, since this one's getting pretty long?
I would yes, as it's already way beyond post #50. I would also perhaps -don't hate me pliz - keep threads predominantly for questions, as opposed to reporting on Angel's numbers (I'd insert these comments into the sheet), which are readily available on her spreadsheet in your signature anyway. This would keep your threads shorter and more to the point. (Although I'm not a mod, so not certain on this part of the housekeeping.)
How is Angel doing? I see she had a lime yesterday (yikes!) and that you gave her a reduction which is perfect. She did better last night, I see.
If you had gotten a +2 test in yesterday’s morning cycle then you would have seen that she was dropping too much or too quickly. Then you could have prevented the lime by intervening with food. Is her appetite good at this point in her recovery? Is she getting a snack at +2? I believe she just grazes, right? Maybe you can make sure she “grazes” around +2? Per SLGS protocol her reduction should have been .25 units. But given that she was so ill and that her appetite may not be what it was before, I feel good about your reduction. And she had a lovely green last night too.
Thanks for checking in @Suzanne & Darcy! Her numbers are flip flopping a bit. That lime green spooked me bad, especially so early on in the cycle when she usually onsets late. She did eat at +1 and +2, so I can only imagine that her own pancreas decided to join the party and produce some insulin and that's why she dropped so fast and low? I was going off the previous number (1.75U) when I shot 1.5U, but I think that was too aggressive considering all the factors (illness, antibiotics & weight loss). So to be safe, I reduced down to 1U and wait and see. After a couple cycles I decided to go up to 1.25U anyways, knowing that was the official reducted dose, and because she's been pretty high in numbers and stable in her appetite. I'll try to hold this dose for at least a week, because I know it's not great that we're changing doses so often. She's got 1-2 more days of antibiotics left, so I'm hoping she'll stabilise a bit too once she's off of those.
