Borderline hypo and nervous

[RockyRoo]

I think I know what I'm doing but want to make sure. My Rocky has been very high sugar recently (>500) and I've been working on changing his diet to lc canned and adjusting his dose. My chart is utd so you can see he was 368 preshot and has dropped to 76 at +5 (using AT2). I checked my meter control solution and did his blood check 5 min after the first so it seems accurate. That is super low for him. He has no symptoms but I gave him some lc canned and will check him again after 20 min. I'm prepared with karo and medium and high carb canned if needed. I haven't done enough curves on him yet to know how his body reacts to shots and I'm not sure what doses to do now?? A little guidance please! His next shot is due at 5am est.

Update ok bg has risen after eating. But still how do I know what dose to use?

 

[Bron and Sheba (GA)]

Hi Allison,
You have done the correct thing to bring RockyRoo up higher again...well done.
I would keep testing to see he keeps coming up.
After that low number, he may bounce up high as he is not used to lower numbers any more.

I have not used Vetsulin so I can't help you with the dose so I will tag @MrWorfMen's Mom for you. She may be asleep though now.
I do think you should probably reduce the doses until you are told otherwise. As far as I remember, they don't like Vetsulin users dropping down below 90.....but I could be wrong

I noticed in the SS that you reduced to 2 units this morning from 4 then back up to 3 units tonight....why was that?

If possible try and get more inbetween tests in because they tell us so much.
Have you read the Vetsulin info
http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.186099/

 

[RockyRoo]

I noticed in the SS that you reduced to 2 units this morning from 4 then back up to 3 units tonight....why was that?

Because his preshot number this afternoon was higher than the one in the morning, so I thought I'd compensate for that since he was on 4 units to begin with. I think I'll stick to 1 or maybe 2 for now until I know more about how his body is reacting! I did read the info but I'm still figuring everything out.

 

[Bron and Sheba (GA)]

4 units is a lot of insulin to start a newly diagnosed kitty off with. The usual dose is around 1 unit and then you go up in 1/4 unit increments as needed. I think I would drop to 2 units and try testing more.
Do you leave food out when you go to work?
A lot of the red and black numbers you are seeing could be bounces, but unless you are testing between shots there is no way of knowing if they are bounces or not.
Bounces will happen if RockyRoo drops too fast, drops too low or lower than he is used to being after being in high numbers.
so what I would suggest you do is try and get some inbetween tests each cycle. If you have to work, try and get a +2 before you leave for work amd a test when you get home. If you are at home try and get some tests in during the +3 up to +8 range to see how low he goes and for how long. Always try and get a before bed test in. And if that is lower than the preshot then you will probably have to test again to keep him safe. I know you work at night so do the before bed test in "your"nighttime..

Is there any history of ketones or DKA?

Try posting each day with the numbers and I'm sure @MrWorfMen's Mom would only be too happy to help you get sorted.

 

[Bron and Sheba (GA)]

I just wanted to also mention that it is really important that you test before EVERY insulin shot to see it is safe to give the insulin.

 

[RockyRoo]

@Bron and Sheba (GA) he isn't newly diagnosed, it's been four years. He did start off around 1 unit, I think, and it's been raised since then. My sister had primary care of him until a couple months ago when I took him. During that time she didn't test him except to do an occasional curve, just gave him his shot as long as he ate a meal. Now I have him and was doing the same until I started reading this forum, so still learning and changing things! He's never been diagnosed with DKA or had ketones tested that I'm aware of.

I am out of the house 13 hrs a day when I work, so really his shot schedule is something like 5:45am and 4pm those days, but he seems to handle it ok. I was leaving canned and kibble out, and now just canned. I am trying to add numbers as I can test him, and will do a full curve my next day off. Luckily he seems like a pretty resilient guy

 

[Bron and Sheba (GA)]

@Bron and Sheba (GA) he isn't newly diagnosed, it's been four years. He did start off around 1 unit, I think, and it's been raised since then. My sister had primary care of him until a couple months ago when I took him. During that time she didn't test him except to do an occasional curve, just gave him his shot as long as he ate a meal. Now I have him and was doing the same until I started reading this forum, so still learning and changing things! He's never been diagnosed with DKA or had ketones tested that I'm aware of.

I am out of the house 13 hrs a day when I work, so really his shot schedule is something like 5:45am and 4pm those days, but he seems to handle it ok. I was leaving canned and kibble out, and now just canned. I am trying to add numbers as I can test him, and will do a full curve my next day off. Luckily he seems like a pretty resilient guy

Good to hear the full story of RockyRoo. He's a lucky boy to have you.
That is really good you are starting to test and learn about FD. Well done!
You can only do what you can when you have to work long hours.
Good to know he hasn't had DKA.
Let's see what MrworfMens says about the dose.

 

[MrWorfMen's Mom]

Hi Allison. Glad to see Bron was here to offer some support last night. Rocky went a little lower than ideal with Vetsulin but he was still safe. You handled the situation perfectly. As Bron mentioned, the goal should be to keep Rocky at 90 or above at least until he gets a bit more regulated. Right now I have a feeling he may have been dropping into lower numbers more than you are aware and then bouncing back up to higher numbers. When the only tests are at the ends of the cycles, you don't see what's happening in the middle and that can give the impression that more insulin is needed when in fact, the dose needs to be reduced. I have to wonder if that is how he ended up on 4u in the first place.

You've recently been transitioning Rocky to a low carb wet diet and that can have a dramatic effect on BG so I am glad to see you reduced the dose. It's important to note that dosing should NOT be based on pre-shots alone. Pre-shot tests tell you if it is safe to give insulin and right now I would recommend you post for assistance if you get a pre-shot reading below about 225 with the AT2 meter. Once you switch over to a human meter (let us know when you do that) then that pre-shot number can be reduced to 200.

Determining dose should be based on how low a dose is taking BG. Last night 3u took Rocky down to low normal numbers however because Vetsulin can cause quick steep drops, we suggest that at a reading of 90 you feed Rocky and try to keep him surfing along in that range. I'm so glad you tested Rocky when you did and wonder if he was showing any symptoms that prompted the extra tests last night? As you get a little more data, you might be able to lower than 90 a little but it's really all about getting to know your cat's reactions and you are just relearning Rocky's behaviour at this point.

Since your work hours preclude getting mid cycle tests during the day, it would be great if you could get a few tests in during the night cycle to see what Rocky is up to. Getting a test around +2/3 post shot will give you clues as to where the cycle is headed and you can then use food to steer Rocky so that he doesn't go too low during the night. If the test at +2/3 post is considerably lower than the pre-shot, it may be an active cycle. Any drops of more than 100 points are a signal, the cycle may be active and you can use food to slow down the drop but you may need to set an alarm and retest him a little later as you did last night. Sometimes folks grab a test in the middle of the night if they wake up to use the facilities.

We also recommend getting a test before bed and making it a habit to do it every night. The more data you can get the easier it is to determine how to proceed dose wise and it will keep Rocky safe.

Given the low last night, I would stick with the 2u dose for the moment but grab mid cycle tests whenever you can (weekends or days off) and at night before bed and if pre-shot is below 225, post for advice. It can take a few days to see the full effect of withdrawing the dry food so it's really important to keep an eye on him right now to ensure he is not dropping too low. Leave food out or Rocky to eat while you are at work. Vet may have suggested only feeding twice daily but that is not safe and allowing Rocky snacks in between meals before shots is actually better for him and will help keep his BG more stable.

One last thing given how high Rocky's numbers have been of late, it would be a good idea to check him for ketones.

 

[Noah & me (GA)]

My compliments on your profile page Allison. Every cat is different and the story is more than just numbers and a spreadsheet.
And yes he is very lucky to have you.

 

[RockyRoo]

Thanks so much for your advice!

and wonder if he was showing any symptoms that prompted the extra tests last night?

No symptoms but it was a night off so I wanted to just see, since I hadn't gotten many midcycle readings yet. I'll be able to get some more tonight, too.

Since your work hours preclude getting mid cycle tests during the day, it would be great if you could get a few tests in during the night cycle to see what Rocky is up to...We also recommend getting a test before bed and making it a habit to do it every night.

So here's the thing - I work long night shifts and I'm out of the house for 13 hrs a few days a week. I usually give him his evening shot around 4pm right before I leave, and his morning one around 5:45 am right when I get home. So I'm not hime to check him +2 in the evening. I generally go to bed right after work too. But on nights I'm off I can check through the night. They generally go lower at night than during the day anyway, right? I do leave him bowls of canned food both times, while I'm working and asleep.

One last thing given how high Rocky's numbers have been of late, it would be a good idea to check him for ketones.

I know how this works physiologically in humans and I'm assuming it's the same for cats, but what actions would be needed if he shows ketones? A vet visit?

 

[RockyRoo]

My compliments on your profile page Allison. Every cat is different and the story is more than just numbers and a spreadsheet.
And yes he is very lucky to have you.

Thank you I'm lucky my husband finally agreed to take him in (he's not a cat person), not just for Rocky's health but because he's such a sweet, cuddly boy. He's been a lovely addition to our house, imo at least lol

 

[Noah & me (GA)]

not a cat person

That is too funny. MIL (mother in law) is living with us and was never a cat person until tiny Andy escaped and we got him back 88 days later. Now she bends over every night to scratch his head and say goodnight.

 

[Bron and Sheba (GA)]

Thank you I'm lucky my husband finally agreed to take him in (he's not a cat person), not just for Rocky's health but because he's such a sweet, cuddly boy. He's been a lovely addition to our house, imo at least lol

Well done to your husband for agreeing to take RockyRoo in!

 

[MrWorfMen's Mom]

No symptoms but it was a night off so I wanted to just see,

Your spidey sense served you well to catch Rocky at that low point. Glad to hear there were no particular symptoms that prompted the test.

On the testing front, test when you can. It's hard when your work hours are that long so use your days off to fill in the blanks. Vetsulin generally starts working pretty quickly so from +2 post shot till about +8 is going to be the most active period of insulin action. Most kitties will hit the lowest point in their cycle between +3 and +6 so concentrating tests in that time frame when you are able will give you the most pertinent data. That said, all data is good data so if all you can get on a particular day other than pre-shots, is a +8/9, go for it.

Most kitties do go lower at night so definitely try to see what Rocky is doing in that +3 to +6 timeframe at night when you have the opportunity.