BG to Low to Shoot, Now What?

Don & Tigger

Don & Tigger

Member
Tigger had been on 2u of Prozinc twice a day until Dec 14 when I noticed his BG number going down and I started backing his doses down. On Dec 25 he was at .5u and I noticed he was sluggish and not eating as vigorously as normal, I checked his BG at +3 and he was 76 (Alphatrack) and knowing he'd be getting lower gave hime some dry food to raise him to 111. My no shoot number is 200.

On the 26th his PMPS was 114, I gave no insulin and dropped his dose to .25u the next morning. Last night (the 28th) his PMPS was 175, no shot given, and this morning (the 29th) surprisingly his AMPS was 167, so no shot.

I'm at .25u and can't really lower the dosage. Should I just continue checking every 12hrs. and give insulin when it goes over 200?? Not sure how to proceed.
 
Sorry, I can't see your spreadsheet. It isn't set for sharing. Some of those BGs are high enough that a tiny bit of insulin is a good idea. People do actually give less than 0.25 u. You can draw up a little more, say 0.5 u, and expel drops until the plunger is just touching the bottom of the zero line. We'd call that 0.10 u. The upper right image shows that. These photos are for a U100 syringe used for dosing Lantus but the same idea applies to your U40s. If Tigger is beginning to need microdoses of insulin you might have to change your "no shot" number to something lower than 200.

someinsulin-1.jpg
01unit-1.jpg

025unit-1.jpg
5e86c3d4.jpg
 
Hi. You could just keep testing and see if he stays where he is or lower. He is still a little bit high for 'normal', and 175 and 167 are really close to 200, so you are likely at a point where he will end up still needing some insulin, just a very small dose. So, if you catch him hitting 200+ again, I think it may be time to put aside the 200 no-shot number and to try giving a small dose on numbers that are a little lower than that provided you are able to monitor. I see that you have no mid-cycle numbers at night at all. It may be helpful to get a test in before bed or to set an alarm to test some time during the night. Cats can run lower (or, in Mia's case, higher) at night, so you cannot assume anything about your PM cycles based on what you see for the AM ones.

@Kris & Teasel I just saw your post come in. I wanted to mention that there are two spreadsheet links in Don's signature. The first one works, the human meter one doesn't.
 
I am in the same boat this am. Amps is 132. I am going to feed and re test in 45 minutes to see if she went up and then decide. Feeding and a re test is an option for you @Kris & Teasel can offer advice on this idea as she is the one who guided me through it the first time.
 
FurBabiesMama said:
Hi. You could just keep testing and see if he stays where he is or lower. He is still a little bit high for 'normal', and 175 and 167 are really close to 200, so you are likely at a point where he will end up still needing some insulin, just a very small dose. So, if you catch him hitting 200+ again, I think it may be time to put aside the 200 no-shot number and to try giving a small dose on numbers that are a little lower than that provided you are able to monitor. I see that you have no mid-cycle numbers at night at all. It may be helpful to get a test in before bed or to set an alarm to test some time during the night. Cats can run lower (or, in Mia's case, higher) at night, so you cannot assume anything about your PM cycles based on what you see for the AM ones.

@Kris & Teasel I just saw your post come in. I wanted to mention that there are two spreadsheet links in Don's signature. The first one works, the human meter one doesn't.
Click to expand...
Oops!
 
Thanks for the quick replies! I believe I fixed the SS links.

OK, good to know that you can eyeball out a smaller dose, I may just wait for the next cycle. Could this be a sign of remission or do some cats actually stay with slightly elevated BG levels?
 
Speaking of SS links- I’ve tried to update my signature a few times and cannot get the changes to stick. Says my sig is too long but the new one is way shorter than the old.
 
Generally speaking, remission happens kind of slowly. You start to see lower BGs, then some days it's too low to shoot and some days it isn't. You shoot on lower numbers than before, and sometimes you need to shoot and sometimes you don't. So yes, I'd say it could be a sign that remission is in the cards for Tigger...but remember it takes some time. The pancreas usually sputter some before coming back to life so don't get discouraged.

Lisa, I know that they updated the length of signatures since I've bene here (which admittedly has been quite a long time). Maybe they updated it again since all those spam attacks? I know they did some updates to the forum to tighten things up. I think your sig can only be three lines long now, so maybe it's hitting a fourth line when you try to update?
 
@Lisa and little You have your spreadsheet linked twice. Once where it says "lisa and little" and once with the full url. You could delete the second one (the url) if you need more space.

@Don & Tigger - not shooting below 200 is just for new folks before they are comfortable testing and understand how to steer. Tigger's blood glucose is still too high to be off insulin. Kris has shared with you the images and doses below 0.25u. It's a matter of trial and error as the PS numbers come down. You give a small dose, and then monitor to see how low it brings him. A normal healthy cat usually has BG between 50-80 with occasional numbers up to 120 (on a human meter). Up to 150 on an AT2 (normal being roughly 68-100ish in that case). So you still have some wiggle room to bring those numbers down a little further.

If you get another PS number like that 114, try stalling for a half hour without feeding, then test again and see if he's risen enough to give a shot. If he's still that low, then you do need to skip on a number like that, but the stalling technique often lets you keep the consistency going until Tigger really is ready for remission. He may well be headed that direction, but you have the best chance of getting him there if you continue to support his pancreas with a little insulin until it really is healed enough to take over on its own.
 
Thanks Rachel & Djamila. I'm so glad I posted the question, I'm onboard with the micro-dosing. After months of PS readings in the 300-500 range, and the fact that I didn't even get a nadir in the 100's until I worked up to 2u, getting PS readings in the 100's seems miraculous.

I kind of thought the pancreas would sputter, which would explain why I had a few other stray PS readings in the 100's.
 
We have always stalled for 30 minutes without feeding then retested. If Frank or Boozle were still too low, we'd stall another 30 and test again. If still too low with Frank, we would skip the shot. With Boozle, it has only happened once where after an hour he was still low. We gave him a half of a dose, but kept a real good eye on him.
 
I'm going to follow this thread if you don't mind! I'm in the same boat with my sugar kitty, O'Malley. Today, he has stayed in the 70-126 range so we didn't shoot tonight either. Even after stalling for an hour, he was only at 92. Love this site, it's been a life saver and sanity keeper!
 
Victoria McCartt said:
I'm going to follow this thread if you don't mind! I'm in the same boat with my sugar kitty, O'Malley. Today, he has stayed in the 70-126 range so we didn't shoot tonight either. Even after stalling for an hour, he was only at 92. Love this site, it's been a life saver and sanity keeper!
Click to expand...

Hi Victoria! Of course it's fine to follow this or any thread. However, since every cat responds to insulin in their own unique way, I would really recommend starting a spreadsheet for your kitty and starting a thread of your own (as well as following along here) so that we can help with any questions you have. Here is a link to the spreadsheet instructions: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
Victoria McCartt said:
Even after stalling for an hour, he was only at 92.
Click to expand...
I think it was wise not to give insulin at this number. We had to give a half dose this evening again, but he was closer to 200. I feel like we are seeing a pretty solid trend, at this point. I just knew, given his history, that he'd be in the blue at test time. He also likes to go in the 40's if we give a full dose when he is not solid into the 200's. I also know he can handle a half dose under 200 without going too low or too high. But that is Boozle.

Djamila said:
However, since every cat responds to insulin in their own unique way, I would really recommend starting a spreadsheet for your kitty and starting a thread of your own
Click to expand...

It's cool that you want to try to learn things on your own, but you'll get advice more tailored to your cat's needs if you start a spreadsheet and ask specific questions about your situation. The spreadhsheet became an indispensable tool for me, long after I quit having questions. It adds visual information to the data, which makes it easier to see trends.
 
Fatina Marie said:
I just knew, given his history, that he'd be in the blue at test time. He also likes to go in the 40's if we give a full dose when he is not solid into the 200's. I also know he can handle a half dose under 200 without going too low or too high. But that is Boozle.
Click to expand...
This is EXACTLY the type of thing we learn about our kitties by doing things the FDMB way! :smuggrin:
 
Tigger's been hanging in the low 100's over the the last 5 pre-shot readings and I've skipping insulin. Today I decided to go with a micro-dose of 0.1u to help him get below 100. I'm very afraid of hypo which is why I skipped prior doses, but the one time I gave a 0.1 shot it only dropped his BG by 9 points at +5.
 
I think he's cruising toward something good. You might need to bite the bullet and do a bit more micro dosing to ease him into it. Get a mid cycle test as often as possible.
 
I've been getting strangely consistent readings between 114 - 116 so I started wondering if the Alphatrack test strips may be faulty, they were delivered FedX last week so were in cold NH temperatures. I just did a +5 check and I got a 70 with the Alphatrack (borderline unsafe) but also checked it with a humane meter and got a very safe 72. Tigger has zero symptoms of hypo, not sure what to do, I have a feeling the Alphatrack may be wrong. I started using the new strips on the AT2 on Dec. 28th, now wondering how accurate my readings are?
 
Don & Tigger said:
I've been getting strangely consistent readings between 114 - 116 so I started wondering if the Alphatrack test strips may be faulty, they were delivered FedX last week so were in cold NH temperatures. I just did a +5 check and I got a 70 with the Alphatrack (borderline unsafe) but also checked it with a humane meter and got a very safe 72. Tigger has zero symptoms of hypo, not sure what to do, I have a feeling the Alphatrack may be wrong. I started using the new strips on the AT2 on Dec. 28th, now wondering how accurate my readings are?
Click to expand...
No, your meter is fine. It's Tigger who is heading toward that thing that shall not be named but starts with the letter "R". This is fantastic! :D
 
Don & Tigger said:
But this is with a tiny 0.15u dose, these aren't insulin free readings.
Click to expand...
Yes, but he's showing you what he can do with a teeny tiny dose. Next step will be a trial without insulin.

From the Lantus forum but it applies here:

OTJ TRIALS:

Prior to starting an OTJ trial, one wants to see kitty mostly in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range.

Remission is achieved when kitty can go 14 days without insulin while maintaining normal blood glucose values under 100 overall. Most will stay in the 50 - 80mg/dL range. Although, some will occasionally experience BG numbers up to 120 mg/dL.
 
Tigger's BG numbers look like he's going into remission. His energy level has increased, and I've noticed his appetite is dropping parallel with his BG numbers. He was eating as much as 4 cans of Fancy Feast with high BG numbers, but that's been diminishing, and the last 2 days he only ate 2.5 and 2 cans respectively, but holding his weight at 11.1 lbs.

I know Kris & Teasel mentioned remission numbers between 50 - 80, but I thought with a cat meter (Alphatrack2) that I would be looking for numbers between 70 -100 and occasionally up to 150, is this correct?
 
Don & Tigger said:
Tigger's BG numbers look like he's going into remission. His energy level has increased, and I've noticed his appetite is dropping parallel with his BG numbers. He was eating as much as 4 cans of Fancy Feast with high BG numbers, but that's been diminishing, and the last 2 days he only ate 2.5 and 2 cans respectively, but holding his weight at 11.1 lbs.

I know Kris & Teasel mentioned remission numbers between 50 - 80, but I thought with a cat meter (Alphatrack2) that I would be looking for numbers between 70 -100 and occasionally up to 150, is this correct?
Click to expand...
I think it can vary a little cat to cat. I'm no expert in remission. ;)

From above:
Remission is achieved when kitty can go 14 days without insulin while maintaining normal blood glucose values under 100 overall. Most will stay in the 50 - 80mg/dL range. Although, some will occasionally experience BG numbers up to 120 mg/dL.
 
Yes, with an AT2, you would look for the numbers being slightly higher, although you don't want more than the occasional number going as high as 150. You really want most of them in the greens or low blues as you said. Tigger is looking great! Fingers crossed he keeps these low numbers going! Keep us posted!
 
The Good News - Tigger has been off the insulin for a week and holding good numbers! I noticed a direct correlation between his BG levels and how much he ate over the last month as BG dropped. He was eating close to 4 cans of Fancy Feast a month ago and gradually dropped to about 2.25 cans when he went OTJ while still holing his weight of just over 11 lbs. I first noticed this when he was on insulin and he wasn't finishing his food (very odd), so I checked his BG and it was pretty low. I figured this made sense since he's absorbing glucose efficiently so he doesn't need as much food.

The Bad News - He came down with a case of diarrhea 4 days ago while dropping to 1.75 cans. I thought it was clearing up but it's not. He's lost weight and has become a finicky eater when and if he eats. At this point I've lost track of how much he's eating since I have multiple cans open and end up throwing some out. I tried the the tuna juice trick, it worked initially, but not anymore. I gave him 2 pellets of his old dry food and he ate them quickly, so not sure if it's completely a loss of appetite or that he just doesn't like Fancy Feast anymore I'm taking him to the vet today, he's had GI problems in the past.
 
I'm so sorry to hear that Tigger isn't feeling well! It's not uncommon for cats to develop an aversion to their regular food when they become sick. They seem to blame the food. Check the food list for an alternative and try offering him some other brand/type until he feels better.

If he has problems like this, you may want to add a probiotic. A lot of our kitties have mild IBD, and a probiotic can make a huge difference when given every day. It takes a little while to build up, but once it does it really helps.

In the meanwhile, slippery elm bark can be helpful in stopping diarrhea. If it's bad enough, metronidazole works well, although the taste is awful, so you may want to get small pill capsules to put it in before pilling. Or make sure you wrap it in something. Cats really hate the taste of it. It is effective though.

Don't let your vet talk you into steroids. Hopefully they won't even mention them as an option since he's diabetic. While sometimes those are necessary, they are a last resort since it will throw him out of remission.

Let me know if you have questions about any of that, and best wishes for a quick recover for Tigger!
 
Thanks Djamila! I just got back from the vet, they're running blood tests, no steroids of course, gave him a shot of Cerenia for nausea, and fluids. As soon as he got home he ran to his food and finished everything in his 2 bowls and most of what I refilled it with! Relief. They prescribed a diarrhea medicine as well. Good to know about the probiotics and that IBD is common.
 
Glad he's eating again! Those cerenia shots seem to work well. You can also get the pills to keep at home. If the cerenia helped though, it makes me wonder if he might have pancreatitis instead of IBD. Do you know if the pancreatitis test was included in the blood work? To be really accurate they need to have been fasting first, so likely not, but sometimes vets will run it anyway just to see what turns up.
 
Yes, they are checking for pancreatitis, it was the vets first concern. The diarrhea also looks unusual, a lot of brown fluid with little solid matter. I just gave him his first dose (of 14) of metronidazole for the diarrhea, we'll see how it goes. I'll get the blood work results on Monday. Appetite still light, maybe a can of FF a day.
 
So it looks like Tigger has made it 14 days and is OTJ! Unfortunately, the vet did an ultra sound and believes he has Inflammatory Bowel Disease. He's had diarrhea for 11 days, diminished appetite and has lost over 1.5 pounds, he's down to 9.5 lbs. The diarrhea medicine he's been on the last week hasn't helped much, since we can't use steroids because of the diabetes the vet is thinking Leukeran, which is a chemotherapy drug, it's expensive and must be handled carefully. I'm not onboard with it, so what about diet? I've heard this sometimes cures it.
 
Last edited:
Don & Tigger said:
So it looks like Tigger has made it 14 days and is OTJ! Unfortunately, the vet did an ultra sound and believes he has Inflammatory Bowel Disease. He's had diarrhea for 11 days, diminished appetite and has lost over a half pound, he's down to 9.5 lbs. The diarrhea medicine he's been on the last week hasn't helped much, since we can't use steroids because of the diabetes the vet is thinking Leukeran, which is a chemotherapy drug, it's expensive and must be handled carefully. I'm not onboard with it, so what about diet? I've heard this sometimes cures it.
Click to expand...
Ask your vet about Atopica. I had an internal medicine vet assess Teasel when he was very ill in May/June. He has evidence of IBD and that was the med she would have used if he'd been worse off. She also mentioned that I could try making his own food and therefore could control ingredients. It's not hard: you have to buy a proper nutritional supplement mix to add to it and the food can be cooked or raw.

This is a good article: https://www.vin.com/apputil/content...35307&id=5709779&ind=184&objTypeID=17&print=1
 
If you're on facebook, there is a good group called "raw feeding for IBD cats" that can help guide you as you get this sorted. If you post, make sure they know that Tigger is diabetic and you're trying to avoid steroids if possible. (He's OTJ right now, but he's still diabetic - just diet controlled)
 
That is an excellent group on Facebook. I joined it and they're very open and helpful. Making your own food isn't hard at all. I do it and have for awhile now and my cats are doing great on it. They are less hungry and not begging at every meal.
 
You must log in or register to reply here.
Back
Top