Help- BG dropping abnormally

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Noct

Member Since 2022
Hello,
I made this account to stalk around and get info without planning to post, I don't have most of the normal intro stuff done, so I'll do the SparkNotes version-
Mica, 14M, diagnosed June 2022
5U morning, 4U night, Vetsulin, AlphaTrak
Started BG 500-700
Normal curves do a 350 high 150 low
Full CBC/IOF blood done in June, I'll see if I can find that

Today:
He was 347 this morning. We started him on gabapentin recently for arthritic hips, and he's been a bit slower to eat since, I suspected he didn't like the gaba. But he ate the same amount as always, just slower.
There was an odd colored (tan) bowel movement last night, but I have multiple cats so couldn't track that.
Gave insulin half an hour after he finished eating (7:30ish).

2:30PM, hear a few odd meows, follow them upstairs and find him- Lateral, pained noises, defecated on the bed, mouth open, harsh breathing. Panicked, called the vet while getting the car. 15 min drive. On and off harsh meows. I fully expected this to be a euthanasia visit.

Immediately tested sugars at the vet: 26.
Gave 5mL dextrose by mouth, plus a little squeezy treats thing.
Placed IV catheter, pushed probably 20mL fluids with dextrose.
Gave about 100mL normal LRS fluids IV drip.
Gave about 3mL more dextrose by mouth cuz they said I could give him more.

Left hind leg was not responsive to pain test between the toes. Vet talked about possible seizure from hypoglycemia and the possibility that he threw a blood clot in that leg which may account for the vocalizations.
Sugars improved to 176 after the fluids with dextrose. Sat with him for about an hour with the LRS drip. He became more reactive, but mostly stayed laying down. Stood him up and he used that back leg again. Sugars were 224 around 3:15ish.
We brought him home to monitor throughout the night and tomorrow. No insulin tonight, test every 2 hours, feed him whatever he wants, monitor that leg. Half insulin tomorrow morning possibly, depending on sugars, then work slowly back up from there.
Got home around 4, he ate a full can of FF and part of a Friskies can (he refused the high carb I have on hand). He stayed in one spot, sitting up but didn't go to walk away at all. I found vomit upstairs, I thought he threw up his morning food when no one was home, and his sugars plummeted.

5:35 tested at home, BG 420. Honestly couldn't even care he was high, I'll take high after that. Since he was high/rising my worry dissipated so much. He still hadn't walked off, but was grooming.

7:42 tested at home, BG 114. No insulin given. I tested twice, low both times. I don't know what happened, or what could be happening.

Vets are obviously closed now, other than ER. I've given him 3mL Karo syrup and offered more food that he hasn't eaten. I don't know. He still doesn't want to get up and walk off, other than to escape me shoving syrup in his face. He's just fallen asleep.

Does anyone have ideas for why his sugars would be dropping like that? I know Vetsulin isn't considered the best on here, but it's been over 12 hours anyways so most insulins wouldn't be working regardless. IV and oral sugars, plus he was eating. Why the sudden drop? I feel like I can't go to sleep if he's gonna drop like that, I'll wake up to a worse scenario than today.

Does anyone have ideas for what I can or should be doing?
 
Hi and welcome to the forum.
I’m sorry you and Mica have been through this.
I am going to ask you some questions to get her information to help you…
Was Mica eating normally up until this happened?
How often do you normally test the BGs?
Do you always test before you give the insulin?
Do you test during the cycles to see how low the dose is taking Mica?
Do you feed the main meals 30 minutes before giving the insulin?
Do you give snacks during the cycles as well as the two main meals?

You definitely need to reduce the dose of the vetsulin. It sound as if he is needing less insulin. The only way to find out is to see some BG data.
Would you be interested in setting up a spreadsheet and adding any recent BG data you have so we can see it and help you with dosing?
Here is a link to the spreadsheet. If you have trouble setting it up, we can help you
Link…HELP US HELP YOU

Keep offering him snacks. Do you have a hypo kit set up?
Bron
 
Thanks for the reply.
I'll look into setting up the spreadsheet, it might take a bit for me to scavenge the old AlphaTrak2 records now that I have a 3.
Mica's been eating the same amount of food, just a bit slower this past week since starting gabapentin. I think he can taste it in the food so he stares at me periodically to see if I'll cave and give him snacks to make him eat (something I did often when he was on DM since he hated the flavor). He would normally eat his full meal within 15 minutes, but has been pushing 30 because of his stares (he's missing a few teeth from a dental cleaning earlier this year too). I spoke to the vet today about other possible options for his arthritis pain too, in case the meds were related.
I run curves every couple weeks when my schedule gives me two days off in a row, that way I can get data later in the night.
I can't say I test every time before insulin, but I do most of the time. I know that's terrible, but budgeting with the insulin/syringes/AlphaTrak strips has been tough. I had started running concurrent curves with a Relion Premier based on things I've read on here, but the two meters disagreed horribly (one would go down, the other up) so I haven't felt confident enough to switch to a human meter because of that.
All morning test have been 300+ since his dental in June, which is honestly a good number for him since he was typically 450-600 before that. His diagnosis numbers were 700-500 curve and we've been fighting to get them down from that.
I do midday tests as much as I can, unfortunately with work it makes it difficult. They've been 190-150 NADIR, down from the 250-300 I would get early on in his treatment.
My mother gives the cats a small midday meal between 12-2PM. When I'm there, I test before he eats.
Insulin is 30 min after. Some days I'm cutting it a few minutes (<5) early to make it to work if he's eating particularly slow, which he does on the occasion. It was a full 30 today since I didn't work.

Hypo kit: Friskies Indoor, Friskies Gravy sensations, and FF Medleys cans. Purina dry which was his old diet. Temptations snacks the other cats loves. Karo syrup.
He's tried to steal these foods from the other cats repeatedly, so they tend to be flavors he likes. He declined the Friskies Indoor this afternoon, so I opened a normal pate FF which he ate immediately.

He was 249 at 9:45. I had given 3mL Karo after his 114 test. I'm sick myself so I desperately need sleep but don't want to leave him if it's gonna drop again. I plan to do another test around midnight and see if he's dropped again, since the 114 drop was about 4 hours after we got home from the vet, and midnight would be 4 hours after the Karo I gave. I might push more Karo at midnight just to ease my mind overnight. I don't want him high, but I'll take a high night over another hypo episode like that. Especially with that 420-114 drop. I plan to run another CBC/IOF this coming week, especially if he isn't bouncing back well.
Also planning to lock him in the bedroom with me and the hypo kit tonight.

Searching around has told me that the IV/oral dextrose from the vet probably gave him an immediate spike to get him out of hypo, which gave me the 420 and a false sense of security that he was ok to just be high tonight. He dropped back to 114 once that immediate spike was gone, sending me back into a panic.
He's been up and walking more now, even went upstairs. Offered more food which he declined, but he's been eating snacks so I'm starting to think he's declining his food just so I give him more treats.
 
If you are finding the expenses too much I would swap entirely to the reliOn meter. A lot of us use them here and they are reliable. You just can’t compare a pet meter with a human meter as they are not comparable.
Swapping to a relion meter would save you a lot of money.
We only need to see a few weeks of BG data
I’ll tag @Bandit's Mom to ask her if you will help you with the spreadsheet set up.
There is no need to give Karo if the BG above 90. With the alpha track meter any BG under 68 is of concern and you should give high carb or Karo then.
Any time you get a BG under 90 you should reduce the dose.
Make sure you reduce the dose of the insulin…for both the am and the pm cycles and don’t go back up even if the BGs go high off the next several days.
If your mother could give him a snack 2 hours after each dose of insulin when you are at work, that would be beneficial. It might help slow the drops.
 
Hello and welcome! I cannot imagine what you and Mica must have been through!

Noct said:
I'll look into setting up the spreadsheet, it might take a bit for me to scavenge the old AlphaTrak2 records now that I have a 3.
Click to expand...
I can help with setting up the spreadsheet. You could start with only the most recent data that you have. Last week or 2 weeks?
 
One other thought is that Vetsulin may be too harsh of an insulin for Mica. It's no longer an insulin that the American Animal Hospital Assn recommends for cats. The preferred insulin is either glargine (which is Lantus or one of the generics), Levemir, or Prozinc. Vetsulin tends to drop blood glucose numbers hard and fast and is too short acting for a cat's fast metabolism. This is a link to the AAHA guidelines.

If Mica's arthritis isn't too bad, Cosequin may be an option. It's over the counter and a form of glucosamine and chondroitin. Adequan or Dasequin are prescription meds that are often used to treat arthritis in both cats and dogs.
 
I would stop mixing the gabapentin with the food if it’s causing him not to want to eat it. Gabapentin is quite bitter. Are you using liquid or capsule? I used to empty the capsule, which was quite large, and divide it up into smaller gel caps that I could pill Minnie with. Or you can compound the gabapentin and get it in liquid form with a flavor added to it. It’s important with insulin that they eat.

I would also consider a better insulin like Sienne suggested. We have lots of resources and online coupons you can use to get generic Lantus at the same price you’re paying for Vetsulin.
 
hi and welcome to the group! The people posting in this thread offering their help are amazing and you can take it to the bank. They saved me and saved my boy Hendrick, who is now in diabetic remission.
 
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