BG Level at a New Low wondering what to do Next

[Ian & Oz]

Hi,
Tonight Oz's BG level was 162 at shot time ( we actually took three readings, 159, 167 & 162 ) this was after having no food for two hours.
We weren't sure what to do so we gave him 1.5u instead of the 1.75u we've been giving him. Really wondering what to do from here, I'm going to take a reading at +5, if he stays in this range or goes lower at the next shot time I need to know whether to give him a lower dose or no dose & how to manage him in the lower levels . Before this he was in the upper 200's & even a few 300's so wondering why the change all of a sudden. I've updated Oz's spread sheet.

Any help would be greatly appreciated.

Ian

 

[BJM]

Lantus effects build up over 5-7 days when starting out and each dose adjustment can take 3-5 days to stabilize. This is due to the carryover effect or "depot". When Lantus is injected, it forms small crystals under the skin. These slowly dissolve, releasing the insulin to take act. Some crystals remain 12 hours later, so the Lantus doses are slightly overlapping in effect. This is how it enables smooth, low glucose levels.

When you start or change a dose, you can get some "new dose wonkiness". The body can react paradoxically with high numbers for a couple of days before it settles down.

When the cat's glucose drops quickly or drops to an unaccustomed low, the body may react with counter-regulatory hormones which release stored glucose (glycogen). This may result in high numbers for up to 3 days.

 

[Ian & Oz]

Hi BJM,

Thanks for your reply.
After his 162 reading at 9 P.M. last night we gave him 1.5u instead of 1.75u because of the lower reading.
At 2 A.M. his level was 254 so back up again. He has been on the 1.75u dose for about five days now, you say that it can take 3-5 days to stabilize on a new dose would that account for the lower 162 reading all of a sudden? Being extremely new to this, when we see a level in the 100's especially the mid 100's we really want/need to know how to proceed, it's confusing since his numbers have been mid 200's.

Thank you
Ian

 

[Phoebe_TiggyGA_NortonGA]

Hi,
It would be good to test in the middle of the cycle when you can (say, once a week?) Somewhere between 4 and 8 hours after injection would give beneficial information.

The goal with controlling blood sugar, is to try and keep it as steady as possible.

If you think of blood sugar going up and down like waves on a lake -- the goal is to get to nice small ripples on the lake instead of giant tidal waves.

At blood sugar levels over 250, there is damage occurring to organs -- think of the sugar as being like sand in the blood - scraping through the body, when the levels are high. So the goal is to achieve blood sugar levels always below 250. This is considered "Well Regulated" and little or no damage is occuring to the organs in the body.

Dividing up the meals into small amounts of food every 2-3 hours helps instead of giving massive meals only 2x per day.

The goal with your insulin dosing is to get your kitty's blood sugar down below 250 but you must be careful that he/she doesn't go too low in the middle of the cycle between shots -- hence why you need to test around +6 hours after the injections.

 

[Shelly & Jersey (GA)]

It's nice to "see" you, Ian! I've been wondering how little Oz is doing. It's definitely scary to deal with those lower pre-shot numbers the first few times you see them.

You're doing a great job testing before every shot. Here's the thing with Lantus, though. We base the dose for Lantus on the nadir - the low point in the cycle. Lantus brings the kitty's numbers down to their lowest point (nadir) roughly 5 to 7 hours after the shot. Every cat is different, though. Some cats reach their lowest point 4 hours after the shot, some 7 hours after the shot, etc. Some cats can be at 300 at the AMPS, go all the way down to 30 at the lowest point, and be back up to 300 by PMPS.

Here's just one example from Jersey: On 3/25, her AMPS was 355. Just 4.5 hours later, her numbers went all the way down to 77. By PMPS, she was all the way back up to 465. :shock:

If I would have only been testing her at shot times, I would have never realized that she had gotten into the normal range on that dose. I would have kept increasing, thinking that the dose wasn't working. That would have been a mistake on my part.

Here's another example from Jersey: On 2/22, her AMPS was 429. Just 6 hours later, she was down to 33. (That's hypo territory.) She was back up to 280 an hour before PMPS. Without getting that mid-cycle test in that day, I may have not realized that just a quarter of a unit was too much for Jersey at that time.

I know I sound like a broken record, but it's so important to try to get at least one test in each cycle. It doesn't always have to be at +5 every night. It could be at +4, +6, +7, etc. Try to grab a "before bed" test every night. If you can, grab a test right before you go to work (even if that's just at +2) or grab a test when you walk in from work (even if that's a +10). Those tests will give us a general idea of where Oz has been during that cycle.

I am not the most experienced person at interpreting spreadsheets, but here's what I see when I look at Oz's numbers: It's possible Oz went lower yesterday (10/3) during the day. Maybe not too low - I can't say that for sure - but lower than that 162 you saw at PMPS. Then Oz "bounced" from those lower numbers during the AM cycle, and that's why his numbers went up last night when you checked at +5. Great job getting that test in, by the way. That's really helpful information to have.

Anyway...that's my 2 cents' worth.
Shelly

 

[Ian & Oz]

Hi Phoebe,

Thank you for your reply!
If you give small meals every 2-3 hours how many meals a day & how large/small are the servings?
We have four cats but just Oz is diabetic.
We (my wife & I) are slowly raising Oz's dose, we are currently at 1.75u twice a day but last night we had a reading
of 162 which was much lower than normal & we weren't sure how to proceed so we lowered the dose a small amount to 1.5u.
We test before every shot & have done a few mid cycle readings as well, I've updated his spread sheet if the levels will help you determine where he is at level wise. I really want to understand what to do to help him, What do you do when you test before a shot & get a much lower reading, do you give a lower dose or no dose? This is especially important as we will keep raising his dose. How long should you stay at a particular dose?

Thank You
Ian