Bella's Erratic readings

D

DianefromDallaa

Member
Bella is a 16.5 yr old with diabetes and CKD. She has been diabetic for 5+ years and was diagnosed with early stages of CKD about 2+ years ago.
Bella has been on Lantus the entire time and has had erratic readings most of the 5 years. She had been on Fancy Feast pates for the first 3 years of her diabetes and then I started her on renal diets. Last November, we started noticing facial twitches. I took her to every specialist in the area and no one could explain a cause. Luckily, the CKD group suggested getting her off renal diet - and a miracle happened. She stopped twitching and gained weight from 7.5# to 9#! Everything seemed good but her glucose numbers.

For all the years, I've actually tested Bella before ANY insulin dose. Her glucose has had some crazy swings - but the last few months have been really odd. I am using Pettest Advocate and almost every measure before a shot she would be "HI" (over 600 BG). She had been on .5 units and sometimes .75 units and would often drop to 50 BG - then shoot back up to 600. The only thing that was changed a few months ago was that I fed her Fancy Feast pate 100% because she seemed to have a declining appetite. But her recent bloodwork showed a HUGE increase in her phosphorus and a big decline in her kidney values. I immediately started aluminum hydroxide and have been trying to get her interested again in Science Diet senior - but so far, no luck. She is being free fed (don't gasp) because I have tried unsuccessfully to get her on a feeding schedule. Not sure if the CKD wreaked havoc on her systems but she didn't do well with a few larger meals.

THE PROBLEM
If you look at her readings the past month, you will see A LOT of high readings - except this past few days.

For the past several days, we are in a good zone. Today, she was ~80 and then it appeared that she was starting to increase. I noticed she was acting weird and she was very cold. Her BG had dropped to 79. I tried giving her some food - but she has barely been eating and wasn't interested.

Its getting very late and her BG is still low. At what point do you just skip a dose? We are already at +13 hours.

If she goes back to running high, what feeding schedule should I try to get her on? I've read through SOOOO many posts and stickys and cant find solid suggestions. Do you feed at the 'lows' or just do small meals all day long.
I'm looking for a plan that I can try.

Please be kind. I've had some harsh words and dropped from the forum for a few days I am extremely stressed as Bella isn't doing well. She's completely inactive almost the entire day which is very unusual for her and just started late October. As I said, her kidneys aren't great. I go for another set of labs next week.

As a side note - my vet felt that we needed to put her on PZI. I told her I wanted to continue Lantus for another month to see what I could do.

Any specific directions would be appreciated.
 
DianefromDallaa said:
For the past several days, we are in a good zone. Today, she was ~80 and then it appeared that she was starting to increase. I noticed she was acting weird and she was very cold. Her BG had dropped to 79. I tried giving her some food - but she has barely been eating and wasn't interested.

Its getting very late and her BG is still low. At what point do you just skip a dose? We are already at +13 hours.
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Just reconfirming...she is 79 at +13 i.e. 13 hours from the last shot? Is she refusing to eat all food? Even a different kind? Can you try some higher carbs and see if that interests her?

What time is it for you?


Link to your previous post on Main for continuity:
https://www.felinediabetes.com/FDMB/threads/huge-swings-in-bellas-daily-blood-glucose.296015/
 
Yes 13 hours from last shot. She's not eaten a 3 oz can today. I have tried several types. no interest - but she is clawing at me for some dry food. I gave her 2 kernels and I bet she's gonna be over 100 soon. She would eat my hand off to get dry food. Not gonna do it though. But I have to get her to eat something and i have 5 open cans right now. She'll eat fancy feast pate but just a few bites.

It's 1am (+15 hours) and she's now at 188 BG. I KNOW this was due to the 2 pieces of dry kibble (Fancy feast dry - yes, I know, its horrible!)
 
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I've been feeding FF pate and she hasn't eaten much all day. I just opened a new can and she ate a few bites.
I gave her cerenia yesterday and today about 6 hours ago. I didn't notice much change.

She loves laying on a heating pad (on low with towels as a buffer). I turn it off every few hours. Oddly enough, she seems to want the heating pad when her BG is low and she got off of it - and her BG is up to 188. (due to the 2 pcs of dry FF).

Do I dose her the regular lantus shot now?

In the past. my vet said not to shoot if she was <250 but that's not what I have seen here. The issue is that it is so late and I would be giving her a shot in 8 hours.
 
If you give her the shot now, you can't shoot again till 11.5 hours after this shot. Maybe 11 hours if she's really high. Can your schedule accommodate delays in the next few days till you get back on track?
 
Yes - so shoot now and in 11 hours if high.
If she’s high at 10 hours, can I shoot? She’s usually high in the mornings.
I worry about shooting when she’s this low ( <200)
 
She might just head up from here in a bounce. I don't know which dosing method you're following, but you can shoot any number over 68 with a pet meter when following TR and over 90 when following SLGS. Especially if you can monitor.

Lantus is very good at giving flat cycles when you shoot low. A preshot is not always an indicator of how a cycle will play out. Cats can drop to low numbers even when starting high and vice versa.

Can you get a test in a couple of hours if you give insulin now? Or you could just skip and shoot at your usual time tomorrow morning. A skip is a good opportunity to change shot times, should you want to do so. You can shoot at any time tomorrow morning and that would be your new shot time.
 
For reference going forward- do I keep same dose if this happens again? How long do you wait? What BG is safe to shoot? She’s dropped so fast in past it scares me - and after 5 years, it takes a lot to scare me.
 
DianefromDallaa said:
For reference going forward- do I keep same dose if this happens again? How long do you wait? What BG is safe to shoot? She’s dropped so fast in past it scares me - and after 5 years, it takes a lot to scare me.
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It depends on which dosing method you choose to follow. With SLGS, you would reduce for every drop below 90. If you're following TR (feed only wet food and can test at least once per cycle in addition to the preshot), you would reduce if she drops below 68 with a pet meter.
 
It’s 2am and based on the other note, I just did her shot.
I hope she will eat. I need to sleep.

I am not comfortable giving insulin when she is low. She’s crashed (<45) when I have in the past. Vet didn’t believe it was possible even though she was only on .5 u. He then saw it for himself on the freestyle. Said in 25 yrs, never had it happen. Welcome to Bella’s world.
 
Bandit's Mom said:
It depends on which dosing method you choose to follow. With SLGS, you would reduce for every drop below 90. If you're following TR (feed only wet food and can test at least once per cycle in addition to the preshot), you would reduce if she drops below 68 with a pet meter.
Click to expand...
I need to read up on the meaning of these terms.
 
DianefromDallaa said:
It’s 2am and based on the other note, I just did her shot.
Click to expand...
OK. This is how many hours after the previous shot? 14 hours? And did you give 0.66U?

DianefromDallaa said:
Vet didn’t believe it was possible even though she was only on .5 u. He then saw it for himself on the freestyle. Said in 25 yrs, never had it happen. Welcome to Bella’s world.
Click to expand...
The size of the dose doesn't matter. It just depends on whether the dose is a good dose for the cat. For some cats, 0.25U can be too much and for other 5U might not be enough!

DianefromDallaa said:
I need to read up on the meaning of these terms.
Click to expand...
SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90 mg/dl. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS but it's also recommended that you get in as many spot checks as you can.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 68 mg/dl (on a pet meter). The aim is to keep the cat in the range of 68-120 (which is the normal BG range for cats with a pet meter). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.
 
DianefromDallaa said:
Bella is a 16.5 yr old with diabetes and CKD. She has been diabetic for 5+ years and was diagnosed with early stages of CKD about 2+ years ago.
Bella has been on Lantus the entire time and has had erratic readings most of the 5 years. She had been on Fancy Feast pates for the first 3 years of her diabetes and then I started her on renal diets. Last November, we started noticing facial twitches. I took her to every specialist in the area and no one could explain a cause. Luckily, the CKD group suggested getting her off renal diet - and a miracle happened. She stopped twitching and gained weight from 7.5# to 9#! Everything seemed good but her glucose numbers.

For all the years, I've actually tested Bella before ANY insulin dose. Her glucose has had some crazy swings - but the last few months have been really odd. I am using Pettest Advocate and almost every measure before a shot she would be "HI" (over 600 BG). She had been on .5 units and sometimes .75 units and would often drop to 50 BG - then shoot back up to 600. The only thing that was changed a few months ago was that I fed her Fancy Feast pate 100% because she seemed to have a declining appetite. But her recent bloodwork showed a HUGE increase in her phosphorus and a big decline in her kidney values. I immediately started aluminum hydroxide and have been trying to get her interested again in Science Diet senior - but so far, no luck. She is being free fed (don't gasp) because I have tried unsuccessfully to get her on a feeding schedule. Not sure if the CKD wreaked havoc on her systems but she didn't do well with a few larger meals.

THE PROBLEM
If you look at her readings the past month, you will see A LOT of high readings - except this past few days.

For the past several days, we are in a good zone. Today, she was ~80 and then it appeared that she was starting to increase. I noticed she was acting weird and she was very cold. Her BG had dropped to 79. I tried giving her some food - but she has barely been eating and wasn't interested.

Its getting very late and her BG is still low. At what point do you just skip a dose? We are already at +13 hours.

If she goes back to running high, what feeding schedule should I try to get her on? I've read through SOOOO many posts and stickys and cant find solid suggestions. Do you feed at the 'lows' or just do small meals all day long.
I'm looking for a plan that I can try.

Please be kind. I've had some harsh words and dropped from the forum for a few days I am extremely stressed as Bella isn't doing well. She's completely inactive almost the entire day which is very unusual for her and just started late October. As I said, her kidneys aren't great. I go for another set of labs next week.

As a side note - my vet felt that we needed to put her on PZI. I told her I wanted to continue Lantus for another month to see what I could do.

Any specific directions would be appreciated.
Click to expand...
No advice but wanted to provide support. :bighug: I too had gotten an unkind comment and it has me not posting now. When you are already stressed those comments are not helpful. I hope there are other kind members on the forum that can help you with this particular situation. Your kitty is 16.5 so you have been a good fur mama to Bella. Good Luck!
 
jillnc1 said:
No advice but wanted to provide support. :bighug: I too had gotten an unkind comment and it has me not posting now. When you are already stressed those comments are not helpful. I hope there are other kind members on the forum that can help you with this particular situation. Your kitty is 16.5 so you have been a good fur mama to Bella. Good Luck!
Click to expand...
Thank you
I have been very grateful for the wonderful support in the past 24 hours! It has given me renewed hope!
 
Bandit's Mom said:
OK. This is how many hours after the previous shot? 14 hours? And did you give 0.66U?


The size of the dose doesn't matter. It just depends on whether the dose is a good dose for the cat. For some cats, 0.25U can be too much and for other 5U might not be enough!


SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90 mg/dl. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS but it's also recommended that you get in as many spot checks as you can.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 68 mg/dl (on a pet meter). The aim is to keep the cat in the range of 68-120 (which is the normal BG range for cats with a pet meter). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.
Click to expand...

thank you sooo much for the good explanation!

I do t think I’ve ever seen Bella in a 60-90 BG range for more than an hour!!!
She is usually flying by those numbers on an increase or crash! lol

She was 225 at noon (Texas time) so I went ahead with a dose - mainly because I may not be home in +6 which is usually when she goes low.

she’s not really been eating so her numbers may go low sooner. I have one more new food to try. I’m up to 9 open cans right now so what’s one more!

I need to find a feral colony for all this food as I throw away soooo much.
 
Bandit's Mom said:
OK. This is how many hours after the previous shot? 14 hours? And did you give 0.66U?


The size of the dose doesn't matter. It just depends on whether the dose is a good dose for the cat. For some cats, 0.25U can be too much and for other 5U might not be enough!


SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90 mg/dl. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS but it's also recommended that you get in as many spot checks as you can.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 68 mg/dl (on a pet meter). The aim is to keep the cat in the range of 68-120 (which is the normal BG range for cats with a pet meter). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.
Click to expand...

I gave dose 2 hours ago at 225 BG and she has dropped to 95 BG. I just gave a new Fancy Feast (Naturals pate that has more carbs) and she's interested and eating.

I am worried her BG will drop <50 since she's already dropped to 96 BG after just an hour.

Is the objective to feed at +2 to slow down the drop? Not sure when the best time is to feed....she does have food out already but hasn't eaten much of the old food.
 
DianefromDallaa said:
I gave dose 2 hours ago at 225 BG and she has dropped to 95 BG. I just gave a new Fancy Feast (Naturals pate that has more carbs) and she's interested and eating.

I am worried her BG will drop <50 since she's already dropped to 96 BG after just an hour.

Is the objective to feed at +2 to slow down the drop? Not sure when the best time is to feed....she does have food out already but hasn't eaten much of the old food.
Click to expand...
We do suggest feeding right before/on onset of the insulin to help temper those steep drops. A lot of us break up the morning/evening meals and spread them out from shot time, +1, +2 , +3. It takes some experimenting to find what works best for your individual cat. You'll get there :bighug:
 
Angela & Cleo said:
We do suggest feeding right before/on onset of the insulin to help temper those steep drops. A lot of us break up the morning/evening meals and spread them out from shot time, +1, +2 , +3. It takes some experimenting to find what works best for your individual cat. You'll get there :bighug:
Click to expand...
She’s been a diabetic for 5+ years and I always free fed. only lately am I seeing big swings.
 
DianefromDallaa said:
It is +4 and Bella has eaten - but she has now dropped to 54bg, down from 95 an hour ago.

she has been eating some of the newer Fancy z feast naturals which has more carbs but it isn’t slowing down her drop.

what do I do?
Click to expand...
Just confirming that the 54 is on a pet meter correct? If so, do you have any high carb food to give, maybe some karo, syrup or honey. Please give her some and test again in 20 minutes and post the next reading.
 
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She’s now 81. Exactly 30 minutes later.

But I had a similar issue in past and she dropped again after going up.
How do you know you are out of the woods? Check again in 30 minutes? Then what?

on thanksgiving she had 3 drops- one was after she increased to 179!

@Angela & Cleo
 
DianefromDallaa said:
She’s now 81. Exactly 30 minutes later.

But I had a similar issue in past and she dropped again after going up.
How do you know you are out of the woods? Check again in 30 minutes? Then what?

on thanksgiving she had 3 drops- one was after she increased to 179!
Click to expand...

You are doing so well. While we wait for the next test, do you mind updating these readings in the SS?

There is a sticky on how to navigate through low numbers. Here it is. https://www.felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/

It's a lot of information so take your time and ask tonsss of questions. We are here to help.

If you can get her to eat, please feed her a little and can you get another test on 30 minutes? I'll be here to look out for the update :bighug:
 
Spreadsheet updated. Last reading was 63 which means she dropped from 81. just gave 2 more pcs of dry food AND HC canned.

Just tested and she’s 65 but acting like she’s lower.

she gobbled gravy HC food!

let’s see if she goes up.
 
Great Job managing the cycle so far :cat:. Can you get another test in 15-30 minutes?

Before I forget, Bella has earned a reduction regardless of the dosing method you are following.
 
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Holding at 71 is good. So to recap - and please correct me if I misinterpreted things:
AMPS 225
+2 95 what did you feed, if anything at this time
+4 54 2 pieces of dry food HC
+4.5 81 what did you feed, if anything at this time
+5 63/retest 65 fed HC canned and 2 pieces of kibble - do you know what % is the HC canned food you fed?
+5.25 71 can you give her a little more food

How about another test 30-45 minutes after that 71?
 
After another 30 minutes she’s 69. Very odd.
I’ll update spreadsheet shortly but wanted to get this update out.

HC food is 20% I believe when I last checked.

I gave 2 pcs of kibble and the HC and she isn’t increasing which is NOT TYPICAL. usually the dry kibble results in an almost immediate increase.
 
Angela & Cleo said:
Holding at 71 is good. So to recap - and please correct me if I misinterpreted things:
AMPS 225
+2 95 what did you feed, if anything at this time
+4 54 2 pieces of dry food HC
+4.5 81 what did you feed, if anything at this time
+5 63/retest 65 fed HC canned and 2 pieces of kibble - do you know what % is the HC canned food you fed?
+5.25 71 can you give her a little more food

How about another test 30-45 minutes after that 71?
Click to expand...
At 81, I didn’t give anything n special. She continued to nibble on the HC gravy.

I’ve been giving the gravy food and am not seeing a solid increase. Not sure what to do.
 
DianefromDallaa said:
I hope the spreadsheet reflects what I got for measures.

54 @ +4
81@ +4.5
63@+5
65@+5.5
71@+5.75
69@+6
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Bella is certainly not making it easy for you this cycle is she :banghead:.
Nice coast so far. How about seeing if she'll have another tsp or two of food and test again in an hour at +7?
 
So even after more dry kibble AND HC food, Bella went up to only 87.

is she safe yet? When do I know? This is the longest I’ve seen her stay low after dry kibble.
Scary because if I had gone out she would have crashed!
 
DianefromDallaa said:
So even after more dry kibble AND HC food, Bella went up to only 87.

is she safe yet? When do I know? This is the longest I’ve seen her stay low after dry kibble.
Scary because if I had gone out she would have crashed!
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87 is a safe number on a pet meter. I would get another test in an hour (+8) to be sure that she is stabilized.
With time and data, you will be better equipped to handle the lower numbers. I am happy that she has eaten for you during this cycle. That's fantastic
You are doing a great job especially since I know how scary all this can be. :bighug:
 
Not experienced enough to advise, just wanted to drop in and say you're doing sooo good! My Bell similarly likes to drop to the low greens and just stick there for a good part of the cycle. She particularly likes to be fed every hour/half hour :rolleyes:.

The data you are getting now on how she behaves at these low numbers will definitely be valuable in the future to help predict how she reacts and how long you need to monitor/feed. For me, the really low numbers are great for my cat but hard on me due to the stress and constant monitoring. Over time, a lot of cats' spreadsheets see a lot less swings and bounces and become very flat and low and predictable. Bell and I are still working on that :)
 
+9 reading was 128

Seems like we may finally be in a safe zone- right?

Very shocking considering the amount of HC food and dry kibble she had today.

Next question- what do I do tonight? What should her number be and should I only do .5 units?

I am not comfortable doing a shot if less that 180-200!
Do I skip or just postpone?
 
Well done. Looks like she's heading up now.

As for tonight, that 54 on the pet meter is a reduction regardless of what dosing method you choose. We typically do dose adjustments in 0.25 increments. May I ask how you're measuring 0.66?
The new dose this evening if high enough to shoot should be 0.41. Maybe get a +11 to get an idea of where you will be for PMPS. I'll tag @Bandit's Mom who should be around during PMPS.
 
I am dosing between the .5 and .75 measure mark on the needle. I asked my vet and she said to call it .67. I would have stayed it as .62. What do you think?

so should plan to be between .25 and .5?? That seems too low.
Does this make sense?
 
Would it be too much trouble to ask you to post a picture of your syringe or the box you get them in? I am no familiar with a brand of U100 syringes that have 0.25 markings.
Unfortunately the upload button doesn't work. We just copy and paste the picture in the reply section.
 
Bella was at 271bg. Gave .5u.
She just doesn’t seem right these past few days. Very lethargic.

Just gave 8mg of Cerenia as all the food changes may be making her tummy upset. Also gave her B12 as her appetite is down - but boy she wanted the dry kibble!
 
I am trying to sleep but thought I would do a quick test on Bella.
I did .5u last night at 271.
She was 288 at +1.
She is now 127 at +6. That was surprising and now a little scary that we are going to repeat yesterday!

I tried updating the spreadsheet from my phone and it wouldn’t save. Not sure why but I’ll update the spreadsheet when I get up. im trying to get extra winks to prep for today.

Worried she will drop lower quickly!
 
Well, she is high and staying there.

I think she has a kidney/urinary infection. She acts very weird when she does. My urine strips show high Leukocytes, normal Nitrites, and a 6.0 pH. That doesn't indicate an infection but I dont know - so off we go to the vet.
 
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