Blood sugar swings and reducing dosage

hobwell

hobwell

Member Since 2019
About a week ago, our cat Geisha was sounding a little panicky around meal time, so I decided to do a spot check on her blood sugar. It was quite low at 2.8 mmol\L.

She has been diabetic for around 6 years and had been at a dose of 5u twice per day for about the first 4.5 years and for the last 1.5 we have recuded it to 4u along with recently reducing her meal portions (3/16 of a cup of dry diabetic food twice per day as of 2019-07-23)).

When I saw her blood sugar that low, I fed her without dosing. When checking that evening it had elevated to around 17 mmol\L, so I gave her 3 units at dinner. The next morning she was around 11 mmol\L so I dosed her 3 units again, but that evening she was at around 7 mmol\L, so I skipped again and gave her 2.5 at the following meal. The next meal she was at 21, so 2.5 again, then tonight 6.9. At this point I don't know whether to dose or not, nor how much. I think I should give her something, but I'm worried 2.5 is going go cause her to go hypo. I'm also not comfortable changing her dose so much so quickly, but we're going out of town for 5 days and I need some advice on what dose to have her given in our absence.

Edit: having fed her, I've given her 2.5 again and will check her in a few hours to see where she is at.
 
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hobwell said:
About a week ago, our cat Geisha was sounding a little panicky around meal time, so I decided to do a spot check on her blood sugar. It was quite low at 2.8 mmol\L.

She has been diabetic for around 6 years and had been at a dose of 5u twice per day for about the first 4 years and for the last 2 we have recuded it to 4u along with a reduction of her meal portions (now 3/16 of a cup of dry diabetic food twice per day).

When I saw her blood sugar that low, I fed her without dosing. When checking that evening it had elevated to around 17 mmol\L, so I gave her 3 units at dinner. The next morning she was around 11 mmol\L so I dosed her 3 units again, but that evening she was at around 7 mmol\L, so I skipped again and gave her 2.5 at the following meal. The next meal she was at 21, so 2.5 again, then tonight 6.9. At this point I don't know whether to dose or not, nor how much. I think I should give her something, but I'm worried 2.5 is going go cause her to go hypo. I'm also not comfortable changing her dose so much so quickly, but we're going out of town for 5 days and I need some advice on what dose to have her given in our absence.

Edit: having fed her, I've given her 2.5 again and will check her in a few hours to see where she is at.
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Hello and welcome to our group.

First, can you please remove the “911”. That is reserved for emergencies like really low numbers bordering symptomatic hypos or other life threatening emergencies like DKA, etc. To remove it, click on “thread tools” and then select “edit title” and then select “no prefix”. thank you.

Not to put you off or not answer your question, but typically, you would want to start here and then on the Main Forum where they can help you get set up with a spreadsheet. This way, we can give you the best advice when we can see the patterns and doses. Are you using Lantus insulin? We don’t hop the dose around like that with Lantus and it would be really unusual to hold a dose, especially such as high one as 5u twice a day for four years.

While I don’t give dosing advice without a spreadsheet (and neither should anyone else), it appears that her dose “may” be too high because she’s dropping, her body is recognizing that the dose at 2.8, is too low, and so her liver is releasing counterregulatory hormones that then cause the blood glucose to skyrocket. You have her in a “dive and bounce cycle” which is not good. With a SS, we can help you with an appropriate dose.

I hope you will hang around and allow us to help you. We have alot of experience :)
 
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Thank you kindly for taking a look, I've removed the 911 and have started preparing a spreadsheet with the recent data that I have. Geisha is on Lantis, which is why I posted in this sub-forum. Should I open a new thread in the Main forum?
 
hobwell said:
Thank you kindly for taking a look, I've removed the 911 and have started preparing a spreadsheet with the recent data that I have. Geisha is on Lantis, which is why I posted in this sub-forum. Should I open a new thread in the Main forum?
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I understand and thank you for starting a SS. Usually, members start through the main forum to set up the correct info on the signature page and learn the basics on testing, feeding, etc. They then move to this sub forum when they’ve got a little experience under their belt.

I know you’ve been dealing with FD for some time. If you can get a SS going and put the following info in your signature block, we can help.

Your and kitty’s name| Geisha’s age| date of dx| Insulin| Meter used| dry, canned, or raw diet| any health problems or meds.

Great job doing the SS and posting it. The more data you can provide on the SS, the better. Please be sure and complete the info in the colored boxes at the top of the SS.

Thank you!
 
Thank you very much, Nicholas. Great job. Dosing method on SS is Start Low Go Slow (SLGS) because you are feeding dry food. Your entry has caused the +8 cell to expand. It’s fine to put your entries inside the colored boxes.

A few tips so we can see what’s going on.

1. In order for us to see her patterns, you’ll need tests. It’s great you’ve started getting the preshots; you can see why it’s important. In addition, I suggest:
  • AMPS, +2 or an “out-the-door” test, and an “in-the-door“ test
  • PMPS, +2, and before bed tests.
If you are not getting any tests besides the preshots, you are missing out on her patterns. I’ve seen cats’ BG go from 300 to 40 to 400 in one cycle; without other tests during the cycle, the cat would look like it needed more insulin. I suspect this is happening with Geisha although we don’t know how low she’s been going.

2. We highly recommend in this forum that you feed a 4-10% calories from carbs canned food or a balanced raw food diet. This post discusses why it’s so important to ditch the dry food. Her blood glucose (BG) will likely decrease if you get rid of the dry. Members can suggest foods to you and there are also food charts.

3. Reading the “stickys” at the top of this forum and asking questions will help you immensely.

4. Posting on this sub forum daily will also help you. Members will stay up with you if you get low numbers and need help. This post will guide you in how to post.

Insofar as her dose, good job that you reduced it to 2.5u. My suggestion is you leave the dose for now and try to get a bit more data. With SLGS, you hold the dose for a week and then do a curve unless she drops below 90. If her BG drops below 90 at any time, you should reduce the dose by 0.25u.

If you decide to change her diet to canned, you must take away the dry food slowly or you could see the BG plummet.

That’s a lot of info thrown at you. Let me know if you have questions. We really appreciate you doing the SS and other info so quickly.
 
Welcome to the forum! Marge has given you a great deal of wonderful advice. Keep posting and we'll see you soon :) Lots of info there to chew on :)
 
Thank you all!

This morning her sugar jumped again (bounced I'm guessing) to 20.5. We are going out of town on Friday until the following Thursday. I'm inclined to lower her dose further to 2.0u in our absence as the folks looking after Geisha aren't at all comfortable with taking blood readings. Does this seem reasonable? I just don't want Geisha to crash while we are away as there won't be someone there around the clock.

So far on 2.5u I don't have an observed low, when would be the best time to try to get that number? +4, +5, +6?
 
hobwell said:
Thank you all!

This morning her sugar jumped again (bounced I'm guessing) to 20.5. We are going out of town on Friday until the following Thursday. I'm inclined to lower her dose further to 2.0u in our absence as the folks looking after Geisha aren't at all comfortable with taking blood readings. Does this seem reasonable? I just don't want Geisha to crash while we are away as there won't be someone there around the clock.

So far on 2.5u I don't have an observed low, when would be the best time to try to get that number? +4, +5, +6?
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Morning, Nicholas. Because you just started this thread late last night, we can continue it, but the next time you post after your trip, it would be best to start a new thread.

Has Geisha been sick, off her food, not drinking, acting lethargic? Anything like that?

The reason I’m asking those questions is because diabetic cats can develop diabetic ketoacidosis if they have an infection, not enough insulin, and aren’t eating/drinking normally. If we have a cat with any symptoms like that or who has had DKA in the past, we are more cautious about how much the dose is dropped back.

If there are no concerns for DKA, dropping her dose back to 2u is best. Because we don’t know how low she is going, it’s better for her to be a bit high than low.

Is it possible for you to pick up some urine ketone strips today and check her urine to verify no ketones? It’s a simple process. Just stick a spoon under her bum as she squats to pee, catch a little urine, dip the strip in it, read it exactly 15 seconds later and compare it to the colors on the bottle. Ideally, ketones should be checked daily if Geisha is not in normal numbers or close to them.

I know it’s only a day before you go, but if you could get daytime tests today at +2, +4, +6, and +10, it would be helpful. If you could also get a +2 and a before bed tonight, also great.

We all look forward to helping you and Geisha!
 
Hello and thank you Marje,

Geisha is acting quite normal, nothing unusual beyond the initial distress on the 10th (sounding a bit panicky to eat). Unfortunately I can only get evening tests today (AMPS+10, PMPS+2,+4), but I can and will take up to +4 in the day time tomorrow.

I will lower her to 2u with tonight's meal and measure from there.

Again, thank you, I'm a bit stressed about leaving her in this state for a few days, but I have little in the way of options at this point.
 
hobwell said:
Hello and thank you Marje,

Geisha is acting quite normal, nothing unusual beyond the initial distress on the 10th (sounding a bit panicky to eat). Unfortunately I can only get evening tests today (AMPS+10, PMPS+2,+4), but I can and will take up to +4 in the day time tomorrow.

I will lower her to 2u with tonight's meal and measure from there.

Again, thank you, I'm a bit stressed about leaving her in this state for a few days, but I have little in the way of options at this point.
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You’re welcome. Those tests will help. We will at least see if she is clearing the bounces fast.

I understand...it’s hard to leave a FD kitty. But sometimes it is just unavoidable.
 
hobwell said:
I managed to get an AMPS +7 and +9, PMPS,+2 and +4 or 5 forthcoming.
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Excellent. She looks to be bouncing and it’s possible she will come lower tonight. The 302 might be what we call “the high before the break” meaning a higher number before we see the bounce clear.

I’ll be looking to see what she does.
 
I just saw the +2 of 166 so she is trying to clear the bounce. Looks like she didn’t quite get there but this dose might be a good one for her. Really great job of testing more today!!!

Keep in mind that when you reduce a dose, the higher dose you reduced from can affect up to six subsequent cycles; on average, it’s about four but I have seen six and more in a few cases.

What that means is that her BG currently is still being influenced by 2.5u. The further you get away from that dose, the more her BG “might” go up. I say might just because we don’t yet have much data for her even at the 2.5u dose.

love the avatar! I’m very partial to brown tabbies. :smuggrin:
 
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I’ve taken a few more measurements today, but she’s now in our caretakers hands. I’ll post more measures when we return next week. Thank you so very much, I have no idea what precipitated this sudden change, but your advice is immeasurably helpful and I am very appreciative. I’ll check in on a new thread in the main forum next week and we’ll take it from there!
 
hobwell said:
I’ve taken a few more measurements today, but she’s now in our caretakers hands. I’ll post more measures when we return next week. Thank you so very much, I have no idea what precipitated this sudden change, but your advice is immeasurably helpful and I am very appreciative. I’ll check in on a new thread in the main forum next week and we’ll take it from there!
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Have a great trip. At this point, I would continue to post here in this sub forum. You’ll get more specialized attention. :)
 
Okie, so we're back! It looks like she's stopped bouncing and settled in on the high side. Our needles make it somewhat difficult to dose in .25 increments, would you suggest trying anyway, with a margin of error, or do you think it's safe to push up to 2.5 with the numbers she's showing?
 
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