Bowel Movements affecting Blood Glucose? Happy in Hypo? Lab - Anything Worrying?

[.:. in.active .:.]

I know every cat is different, but mine seems to behave differently regarding this whole diabetes madness, and I'm losing my marbles over it. It's like he is the "exception to prove the rule".

To begin with, he is and has been asymptomatic unless he crosses the 33 mmol/L ~ 500 mg/dl threshold, but even then his symptoms are moderate (ravenous), only presents polydipsia and polyuria in his 40s ~ 700s. Vet here noted he's not a textbook diabetic. Fine, we move.

But...

1. Have any of you noticed your cat's BG would drop significantly after urinating and/or a bowel movement?
As far as I'm aware (and was told by vets, human doctors and fellow diabetic cat owners) these shouldn't account for lower BG readings, unless the patient is constipated and it putting pressure (aka stress factor) on their bodies. My cat has regular bowel movements, approx. one every day-and-a-half. (Granted he used to lay stinky landmines daily, but that was pre-Dx when he was free fed and ate as and when he pleased, and wasn't "restricted" to only two main meals and snacky snacks in-between.)

2. Do any of your cats is happy in hypo? Does such thing as 'Happy Hypo' even exist?
My boy has crossed the hypo threshold for the first time yesterday at AM+6 (3.7 mmol/L ~ 67 mg/dl) but he was his old, happy, playful, purring content self. So much, I didn't even see the point of testing at that time, only did because I hadn't at AMPS and recently he's been giving me suspiciously nice and low readings around nadirs, so already having had to reduce his dose. His behaviour did not at all reflect the number he has given me. I Karo syruped him up, his BG immediately raised up to a safe level, but as soon as he hit 10 mmol/L ~ 180 mg/dl he became his miserable, lethargic diabetic self again.

I'd also like to mention here, that upon his diagnosis whilst chatting to the vet, they noted that some (non-diabetic) cats may read lower than the standard textbook threshold, but it is of no concern, as long as they're their normal, happy selves. This aligns with his 'Happy Hypo' I guess, but definitely won't be something I purposely seek!
They also mentioned, since he is diabetic, it is unlikely I'll ever see no glucose in his blood, some always will be present, even once he is regulated. ??? I would bloody hope so! Even if I have misheard and they talked about glucose in his urine (which they definitely weren't), that is incorrect too, as far as I'm aware anyway. Please correct me if I'm wrong, but I thought glucose only spills into urine above a 10 mmol/L ~ 180 mg/dl BG reading. Unless...

3. Should I be worried about any other underlying issues especially future CKD?
They did some labs, albeit very limited, and they then said his kidneys were fine and had no UTI either. I have some numbers and abbreviations, but I can't make much sense of them, and can't find much online I could compare these numbers to. We have an appointment with a different, private vet on Friday, and I do wonder whether I should be aware of anything I should bring to her attention.
Could you maybe help me out with these please? Is there anything out of ordinary here?

March 21st
Path Internal - Blood
Total Protein - 75
Glucose - 30.5
ALB 39
ALP 71
ALT 56
GLOB 36
BUN - BUN 12.9mmols
CREA 136g/l

May 4th
Diagnostic - Urine
USG 1.030
pH 5
Leuk 3+
Pro +1
Glu +4
Ery/ Hb +4

 

[Nimi S]

2. Do any of your cats is happy in hypo? Does such thing as 'Happy Hypo' even exist?

Hello!
I’m a newbie here (only about 1.5 months on Lantus) and thought I’d share my experience of my cat Shen’s low BG numbers. He’s had 5 instances where his BG dropped between 45 and 50 mg/dl (on a human meter) and not once has he shown any of the usual hypo symptoms. All of those times, he had been sleeping away and I came across those numbers because they fell within my usual testing times. Shen has never been a Happy cat - hungry, grumpy and sleepy are his defining characteristics

I’ve read that a cat can be under 50 but not have a symptomatic hypo. What I usually do when his BG goes below 50 is to give 2 teaspoons of his usual LC food, some creamy treat (HC) and a tiny bit of honey and check his BG after 20-30 mins. If it’s still low, I repeat this minus the honey (unless his BG has not gone up at all) till it’s up to 70/80 (which are numbers that I'm now comfortable with).

I’ve also read that a cat could be fine one moment, and hypo the next. So a lack of symptoms only makes me more paranoid about encountering one. I tend to jump to conclusions, so home testing has been my best friend, especially when I newly encountered lower than usual BGs.
Some animals are very sensitive to even mild hypoglycemia, others give no obvious clues even when the levels are getting into what is generally thought to be dangerous territory. Bottom line still is ECID

They also mentioned, since he is diabetic, it is unlikely I'll ever see no glucose in his blood, some always will be present, even once he is regulated. ??? I would bloody hope so! Even if I have misheard and they talked about glucose in his urine (which they definitely weren't), that is incorrect too, as far as I'm aware anyway. Please correct me if I'm wrong, but I thought glucose only spills into urine above a 10 mmol/L ~ 180 mg/dl BG reading. Unless...

For a non-diabetic cat, the normal range of glucose in the blood is between 70-120 mg/dl. No glucose in a cat’s blood, diabetic or not, would be equivalent to or worse than hypoglycemia.

As you are saying, the vet may have been referring to glucose in the urine, since a regulated diabetic cat has glucose generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs and no hypoglycemia. Since the renal threshold can be anywhere from 180mg/dl and up (ECID), there’s a chance that a regulated diabetic cat’s glucose spills into their urine.

Shen’s urinalysis showed glucose in his urine when his BG was 312 mg/dl a month back. His most recent (today) urinalysis did not show any glucose in his urine now that his BG has stayed below 200 mg/dl for a couple of weeks now.

1. Have any of you noticed your cat's BG would drop significantly after urinating and/or a bowel movement

I don’t have any experience with your point regarding any correlation between bowel movement/urination and BG numbers. I don’t think there are any studies pointing to this, especially for diabetic cats. A Google search says that anecdotal evidence and individual experiences for diabetic humans show that although there can be a correlation between bowel movement or urination and a drop in blood glucose levels, the relationship may not be direct or significant for everyone. Exercise and movement can enhance insulin sensitivity and glucose uptake by the muscles, leading to improved blood glucose control. However, the impact of bowel movements on blood glucose levels may not be as significant as other factors such as insulin administration, diet, and overall diabetes management.

The decrease in BG could be due to physical activity (movement and muscle contractions) involved in BM and urination, which might help the body utilize glucose more efficiently and potentially lower blood glucose levels. Another reason for it could be that BMs and urination can trigger hormonal responses that affect glucose metabolism. Yet another reason is that increased fluid intake during urination can help dilute glucose in the bloodstream and lead to lower blood glucose readings.

I think it’s an interesting observation but not something you might want to be overly curious or concerned about, unless the quality / frequency of poop/urination becomes bad

I have some numbers and abbreviations, but I can't make much sense of them, and can't find much online I could compare these numbers to.

If you want to, whenever you have some time, you can add a LABS tab to your spreadsheet and enter Rorschach’s labs. It helps to be able to view and compare subsequent lab results next to each other/normal ranges and to see changes in parameters over time [/QUOTE]

 

[.:. in.active .:.]

I’m a newbie here (only about 1.5 months on Lantus)

Hey Nimi, thank you so much for your input! To me it doesn't matter whether you're a newbie or not. We are all in the same boat, after all. At least Shen is on Lantus (we are still dealing with the nightmare of Caninsulin)... And look at all that greenery in your sheet since early May! Not to mention with the dose keep dropping! Well done to your little trooper!

What I usually do when his BG goes below 50 is to give 2 teaspoons of his usual LC food, some creamy treat (HC) and a tiny bit of honey and check his BG after 20-30 mins.

Yup, I only tested because it was his AM+6, but since he was behaving like his pre-diabetic self, I didn't even think I may be seeing such a low number. When mine tested 3.7 ~67 [we are using a pet meter] he happily licked the karo syrup off my finger, but I've also mixed a little bit into his post-poke yoghurt treat, which is already higher in carbs (about 3% in that little 15ml sachet). He's BG gone up to 5.2 ~94 within 10mins. But two hours later, as soon as he crossed the 10.0 ~180 mark he became miserable again. It honestly breaks my heart. Not that I would purposely leave him hanging so low, but because at this point it feels like anything I do is for his disadvantage. (I know it's not me, it's the fact we are on an awful, quick and aggressive insulin still, but you know what I mean...)

No glucose in a cat’s blood, diabetic or not, would be equivalent to or worse than hypoglycemia.

Exactly my thoughts.

As you are saying, the vet may have been referring to glucose in the urine.

See, the issue is that up until now (hopefully Friday is our day!) we've been under a government funded veterinary clinic, which is... great for keeping the pets alive, but necessarily looking at what is the best for them. Long story short, upon each visit you end up being seen by the first available vet out of the 3 or 4 working on that particular shift. And they all tend to say different things. One of the very first people we've seen straight up told me that they don't look at glucose in the urine, only ketones. Then, on another occasion, I was told that it is unlikely that I will not see glucose/have a nil glucose reading... (Mind you that they were against me home testing BG, and at the point when this conversation took place I didn't even say I'm testing ketones/glucose in the urine.)
He's urinalysis always reads the highest for glucose. Thus why I'm so concerned about his kidneys becoming affected sooner or later.

If you want to, whenever you have some time, you can add a LABS tab to your spreadsheet.

The closest to "lab results" I have are those numbers I have copied above. I can see your Labs Tab is super detailed and have the explanation of each abbreviation. I find it super helpful, thank you! If you're seeing someone in your sheet for an extended time, it will be me, trying to make sense of my own numbers

A Google search says that anecdotal evidence and individual experiences for diabetic humans show that although there can be a correlation between bowel movement or urination and a drop in blood glucose levels, the relationship may not be direct or significant for everyone.

This is all I have found too. Not very reassuring, when he let alone not yet regulated so his pre-shots are all over the place, but they may even differ by as much as 10 ~180 just because he does a dump overnight. Same goes to his nadirs dropping by as much as 5 ~90 after a bowel movement.

At the moment everything is inconsistent. His behaviour, his numbers, whatever the different vets have been saying, and most of all, the way this bloody awful insulin behaves in his little body. There are way too many variables at play, and it's driving me crazy trying to figure out which variable accounts for what.

 

[Larry and Kitties]

May 4th
Diagnostic - Urine
USG 1.030
pH 5
Leuk 3+
Pro +1
Glu +4
Ery/ Hb +4

The pH is a little low
Disregard the Leuk 3+ since in the leukocyte pad on the urine dipstick is of no use in veterinary medicine
The Pro(tein) +1 could indicate some kidney degradation
The Ery/ Hb +4 indicate red blood cells in the urine which could be an infection or another problem. Was the urine sediment looked at under a microscope to look for while blood cells, bacteria and other things?

 

[.:. in.active .:.]

The Pro(tein) +1 could indicate some kidney degradation
The Ery/ Hb +4 indicate red blood cells in the urine which could be an infection or another problem.

Son of a...
I made her take a urine sample because I was worried about infection and/or UTI due to his BG not dropping back then, she said not likely cause there's no visible blood in his pee. When I went in again 10 days later I caught her (she was working next to the vet we saw) and asked to look at the results and she told me everything was fine!
Didn't mention anything re: kidney either, and it's on their records that I'm worried about it and is something I want to be looked at regularly.

Was the urine sediment looked at under a microscope to look for while blood cells, bacteria and other things?

Probably not, it's PDSA after all...

God, I'm livid! It'll be almost a month since the above test, when we finally see the new vet on Friday the 2nd.
Thank you so so much for this, I'll be asking them to look into these.

 

[Nimi S]

we are still dealing with the nightmare of Caninsulin

Hope you get to transition to a better insulin soon, whether that be Lantus, Levemir or Prozinc. Shen also was on a completely useless insulin that did nothing for him. Thankfully I could get resources in order to switch Shen to glargine. I think that's the best thing that's happened to him in a while

But two hours later, as soon as he crossed the 10.0 ~180 mark he became miserable again. It honestly breaks my heart. Not that I would purposely leave him hanging so low, but because at this point it feels like anything I do is for his disadvantage. (I know it's not me, it's the fact we are on an awful, quick and aggressive insulin still, but you know what I mean...)

I feel you. The insulin that Shen was on (only for the first 10 days thankfully) would work for like 4-5 hours at best. I did not know what to make of those pinks and reds on his SS. The high BGs had him looking deadbeat all the time.

Long story short, upon each visit you end up being seen by the first available vet out of the 3 or 4 working on that particular shift. And they all tend to say different things.

I wish I could say that I don't relate to this but unfortunately I've had this experience with another one of my cats. One would think that it's a great thing that you're getting multiple opinions and at least a few of them would make sense. But nope.
When Shen was first diagnosed, one vet suggested a useless insulin. Then suggested increasing his dose from 1U twice daily to 2.5U twice daily (can you imagine?) Another vet asked to wait for a month to see if the steroid wore off and his BG came down on its own before starting insulin. Yet another suggested to stick to dry food (24% carbs) that Shen was earlier on. Phew!
Of course, there must be some good vets for cats. I'm still on the look out for a decent vet that I can trust to take care of Shen. But for all things FD, I come here.

He's urinalysis always reads the highest for glucose. Thus why I'm so concerned about his kidneys becoming affected sooner or later.

When I first got a urinalysis done, I was trying to ensure that there were no ketones, since Shen was in high numbers then and I was afraid that I might be not reading the keto-diastix properly. Turns out Shen had a UTI.
In my head, I've diagnosed Shen with so many conditions that it's embarrassing. I couldn't always find an answer for some of his symptoms or behaviors, so I tried to put my fears to rest by doing complete blood work, urinalysis and an ultrasound. In hindsight, the ultrasound feels excessive but once I got it out of the way, I could focus on treating the UTI and taking care of his insulin needs.

This is all I have found too. Not very reassuring, when he let alone not yet regulated so his pre-shots are all over the place, but they may even differ by as much as 10 ~180 just because he does a dump overnight. Same goes to his nadirs dropping by as much as 5 ~90 after a bowel movement.
At the moment everything is inconsistent. His behaviour, his numbers, whatever the different vets have been saying, and most of all, the way this bloody awful insulin behaves in his little body. There are way too many variables at play, and it's driving me crazy trying to figure out which variable accounts for what.

It really is overwhelming in the beginning. I also would try to figure out Shen's BG trends and drops, in the beginning, to see if I could catch a potential hypo or even a simple nadir. But it takes a while to achieve any kind of regular trend (even with Lantus in my experience). I gave up after a while and now I go about it all in a pretty mechanical way.

Give yourself breaks every now and then (I really should take my own advice ). It's a lot of information to process in a very short time. I'm still reading and still learning.

All the best to you and Rorschach Hope the new vet is better and can figure out if there's something up with his kidneys and nip it in the bud

PS: Sorry for the long replies. I would find stories similar to my own reassuring while I was starting out here, hence the over-sharing

 

[.:. in.active .:.]

PS: Sorry for the long replies. I would find stories similar to my own reassuring while I was starting out here, hence the over-sharing

ADHD? Because I do exactly the same, so no need to apologise

Hope you get to transition to a better insulin soon, whether that be Lantus, Levemir or Prozinc.

In all honesty, my mission for Friday is to push for Lantus or Levemir. Where I'm based, the costs of those are quarter of the cost of ProZinc!

In my head, I've diagnosed Shen with so many conditions that it's embarrassing.

Hahaha listen, two months ago I was convinced he had thyroid issues, then two weeks later I was sure his heart is failing and he has cancer! Not to mention I'm now watching my other two cats like a hawk, following them around with a Keto-Diastix too, just on case.

Hope the new vet is better and can figure out if there's something up with his kidneys and nip it in the bud.

I've compared his (very limited) blood work to your labs (again, super helpful that you've categorised it, e.g. "kidney function") and he was in the clear... two months ago, that is.
His creatinine and BUN-creatinine ratio seems off, but I don't know what that means, and it might just be the conversion e.g. decimals. But I'll add that to tomorrow's list of 'what shall I hyper-focus aka stress about this time'.
Larry's above message did ring some alarm bells, given that those numbers taken from his urine are more recent, but we will see.
I think asking for blood work and urinalysis again at this point wouldn't hurt, especially since upon diagnosis he was still well and fine (minus being ravenous, and drinking and urinating heaps), e.g. all the weight loss started after, when he was already on insulin... So God knows what else he may have developed in the past two months, trying to get regulated on an insulin that is pretty much impossible for a cat to regulate on. (Hopefully nothing tho, but better be safe than sorry.)

Give yourself breaks every now and then.

You know the saying; No rest for the wicked. But only a couple of more days, and we'll be seen by the vet, fingers crossed she knows what she's doing, and will be doing that good and proper.

Edit: His creatinine was 136umol - 1.54mg/dl 2 months ago, which was just below the 140umol - 1.6mg/dl threshold of Stage 1. Now I'm worried again cause these numbers likely be higher now... Friday can't come soon enough.