BG drops in the afternoon

[run4life10]

Pumpkin is doing well, but one thing I am consistently seeing is her dropping really low around mid-afternoon (approx. 2pm-4pm). She seems to be well-managed the rest of the day, and she eats 4x/day but she seems to have these drops in the afternoon regardless of how much she eats during her mid-day feedings. Has anyone dealt with this and does anyone have any suggestions for managing this? I'm often not home in the afternoons so I really worry about her having a hypoglycemic episode while I'm gone. She seems to average 40-50 during these drops, and the rest of the day is usually 150-250. Right now she is on prescription DM canned, just switched from all raw. We moved a couple weeks ago and she stopped eating altogether, so I had to take her off the raw and give her canned just to get her to eat something. She is eating it but often needs a lot of coaxing and still does not finish her meals. But even when I am able to get a full meal in her in the afternoon, she is still having these drops. Is there something I can add to her afternoon meals to prevent this or anything else I can try?

 

[MrWorfMen's Mom]

What you are seeing may be totally normal but without a bit more information it's impossible to say for sure.

You've indicated those low readings occurred between 2pm and 4pm. The members here live all over the planet so we don't deal in clock times but rather in how long after an insulin shot, the readings occurred. How many hours after you gave the insulin did you get those low readings?

A normal Lantus curve would look like a smile if you were to graph the readings from shot to shot with the lowest point in the smile occurring roughly in the period 4 to 7 hours after the last shot. So you will see higher numbers at both the beginning and end of each 12 hours with a dip in the numbers roughly in the middle of the 12 hour cycle.

While a reading of 40 to 50 would be normal for a non-diabetic cat, that's getting a bit low for a cat receiving insulin and suggests a dose reduction may be needed to keep Pumpkin safe. Are you taking any readings at night? I ask because a lot of cats go lower at night than they do during the day and Pumpkin may be going dangerously low at night on his current dose.

We have a very helpful spreadsheet you can use to track Pumpkin's BG readings and it would help us help you if you would set one up for Pumpkin. If you are interested, the instructions for setting up the spreadsheet are HERE and THIS document explains how to use it. If you have any difficulties setting up the SS, just holler and we can help you out.

 

[run4life10]

What you are seeing may be totally normal but without a bit more information it's impossible to say for sure.

You've indicated those low readings occurred between 2pm and 4pm. The members here live all over the planet so we don't deal in clock times but rather in how long after an insulin shot, the readings occurred. How many hours after you gave the insulin did you get those low readings?

A normal Lantus curve would look like a smile if you were to graph the readings from shot to shot with the lowest point in the smile occurring roughly in the period 4 to 7 hours after the last shot. So you will see higher numbers at both the beginning and end of each 12 hours with a dip in the numbers roughly in the middle of the 12 hour cycle.

While a reading of 40 to 50 would be normal for a non-diabetic cat, that's getting a bit low for a cat receiving insulin and suggests a dose reduction may be needed to keep Pumpkin safe. Are you taking any readings at night? I ask because a lot of cats go lower at night than they do during the day and Pumpkin may be going dangerously low at night on his current dose.

We have a very helpful spreadsheet you can use to track Pumpkin's BG readings and it would help us help you if you would set one up for Pumpkin. If you are interested, the instructions for setting up the spreadsheet are HERE and THIS document explains how to use it. If you have any difficulties setting up the SS, just holler and we can help you out.

Thanks for the info. These low readings are approximately mid-dose since she usually gets her insulin around 8am and 8pm, and while I understand the curve, I'm concerned about the numbers themselves. How low is too low that I should start worrying? She has never had any low readings at night, only during those afternoon times approximately 5-7 hours after insulin. I guess I'm still trying to understand what "normal" numbers really look like. The vet seemed to be concerned about the afternoon dip as well when they did a curve, but she was still a bit high at other points so they did not want to decrease the insulin. She is only getting 1 unit now, so there is not much room to decrease, but even when she was on 1/2 unit before she still had these dips in the afternoon. I'm just wondering how low is too low?

 

[MrWorfMen's Mom]

Normal BG is not the same each and every day even for a non diabetic cat. The goal for a diabetic cat is to keep them in optimal BG range for as long during each 12 hour cycle as possible. While a cat is on insulin, if you are using a human meter for testing, then you really don't want Pumpkin going below 50. That 50 limit provides a tiny cushion of safety as some non diabetic cats can normally have BGs in the 40s. If you are using a pet meter, then those low readings become even more of a concern. I have a diabetic cat in remission and once got a 36 on a human meter when checking to make sure she was holding good BG range. Under no circumstances do you want to maintain the same dose if Pumpkin is dropping into the 40's while receiving exogenous insulin.

From what you are telling me it seems Pumpkin is reaching those low readings around 6 to 8 hours post shot. Have you tested Pumpkin in that time frame on a night cycle i.e. 2 to 4 am time frame? If not then I don't think you can be certain the lows are not happening in the night as well. Pumpkin could in fact be going even lower.

If I were you, I'd drop the dose to at least 0.75u (half way between the half and full 1u mark on the syringe) and test to see what BG does at that dose. You have indicated a 0.5 u dose resulted in the same dip but were the readings as low as they are on the 1u dose? It may be that Pumpkin is bouncing a bit because of the size of the BG drops or he/she may just be a bouncy kitty. I'd also set an alarm to check BG in that 6 to 8 hour post shot time frame at night to see what Pumpkin is doing in the night cycle. Without seeing more data in a more visual way, it's difficult to guide you but I definitely think you need to be cautious with readings dropping into the 40s while giving insulin.

 

[run4life10]

Thank you for all the info! I am using a pet meter for testing, why exactly does that make those low readings even more of a concern?

I see what you're saying now. It had never occurred to me to be checking her throughout the night, but I will definitely try to get a reading around that time at night. I am also hoping to get a full curve on her soon, but her appetite has been all over the place since we moved so I was trying to wait until she gets into more of a routine. Her appetite seems to be improving a bit in the past couple days but she's having trouble getting back onto a schedule and is preferring to just graze throughout the day.

 

[MrWorfMen's Mom]

With a pet meter, your warning of BG potentially going too low is 68 so readings in the 40s and 50s are definitely far too low.

Please reduce the dose and monitor closely. If you get a reading that low, you need to give Pumpkin some higher carb food and keep checking BG every 20 to 30 minutes until BG is back up over 68 and staying there without more food needed to keep BG up.

Can you please add the type of meter you are using to your signature as it makes a big difference in the advice you will get should you need assistance for any low readings.

It would also be helpful for those trying to help you if you would set up a spreadsheet to keep track of Pumpkin's BG readings. If you are interested, the instructions are HERE and THIS document explains how to use the spreadsheet. If you have any problems setting up the spreadsheet, let us know and we'll help you get it going.