Help! Switched to Low Carb Food and BG Very Low

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Critter Mom

Critter Mom

Member Since 2014
Hi all,

I've only joined the forum recently since my Saoirse was diagnosed with diabetes and comorbid pancreatitis. I've been trying to read lots of information on the forum as I try to get my head around how to help my beloved pusscat. (My thanks to Michelle, btw, for the warm welcome on the "Fur Pulling" thread.)

Saoirse and I have had a very rough few days since she reacted badly to a spot-on worming treatment. The first vet that treated her had prescribed 3IU BID Caninsulin and Hills w/d Dry (I know, I know :roll: ) for her diet. I wasn't happy with this protocol or the first vet's dismissal of my wishes to home test Saoirse so I moved to a different veterinary practice. My new vet is very pro home testing and supports use of low carb food for diabetic patients.

I had already planned with my vet to switch Saoirse over to a suitable low carb food (currently Purina DM canned, but hoping in time to move her on to a better quality food such as Granatapet). Saoirse's bad reaction to the parasite treatment resulted in her wanting to eat but not the w/d. Thankfully the Purina DM arrived yesterday and she's now back to eating properly.

The very necessary but regrettably abrupt switch to the new food is upsetting her digestive tract somewhat but her blood glucose levels have tumbled since she started on it, and this evening they dropped very low: 4.3 mmol/L; 77mg/dL). (On the w/d she was peaking at 450 and had a nadir of around 300 between +3 and +6-ish on a good day.) Thankfully Saoirse was not showing any signs of a hypo. I spoke to my vet's OOH service and fed her some more DM Canned, which she scoffed enthusiastically. I retested and her BG is now up to 225. Thing is, I've had hardly any sleep in the last couple of weeks (I have PTSD alongside the worry about Saoirse). I'm running on fumes myself and I'm about to pass out from utter exhaustion. I live alone and I'm hanging on by my fingernails to post this. I just won't be able to stay awake. I need to leave food in Saoirse's timed feeder but I don't know what's best to give her or how much. I have both Purina DM Canned and Dry formulations available.

If any forum members are around, I would greatly appreciate a steer on what food might be better, and how much to give her. Or would it be better to leave food out so she can help herself? I can't get the insulin back out. Help!!

Here are her numbers from today:

351 - Pre-insulin
184 - +3
184 - +6
367 - Pre-insulin
167 - +3.5
160 - +5.25
176 - +6.25
328 - +9.5
310 - Pre-insulin
77 - +3.5
225 - +4.75

She is on 3IU Caninsulin BID (08:30 and 22:30 BST). She gets 40g Purina DM Canned every 4 hours (small regular meals necessary to prevent her from vomiting).

I'd very much welcome any suggestions if anyone's around. I'm really very worried right now.
 
I'm glad you've started testing blood sugar at home. Good job!

Any diet change can require an immediate reduction in dose. 3U of insulin is a LOT for a recently diagnosed diabetic cat.

Caninsulin is a strong insulin intended for dogs. It only lasts about 6 to 8 hours in cats, so it is like a roller coaster of low and high blood sugar.

Immediate -- please leave food out all night for your kitty. Most cats instinctively eat when they need to IF THEY CAN. If they cannot walk or cannot eat and have low blood sugar, syrup or honey can be rubbed on the gums while you are taking kitty to the ER vet.

1. Please reduce the dose. You don't want to go any lower than 77 at nadir (the lowest point), and if you change the food, your kitty will go lower.

2. Ask your vet about changing to Lantus or Levemir insulin. I prefer Levemir and have been using it for my cat Tiggy since 2009.

3. Read www.catinfo.org for feline nutrition info -- choose low carbohydrate canned foods with 10% or less carbs. There is a list of many canned foods and how many carbs (and protein, fat, phosphorous, etc content)
 
Phoebe, thank you so much for such a quick reply.

Following your recommendations. Will post again shortly.
 
Just tested again.

302 - +6.5

She normally has 40g DM canned per meal, but when she hit the low earlier I gave her another portion of 40g. She ate the full 80g with gusto.

I've just tried to interest her in some of the DM dry. She doesn't seem very hungry at the moment after her earlier monster feed. I managed to coax her into taking 2g of the DM dry. Also tried some DM wet (slightly warmed in microwave) but she just doesn't want it. (She has never been a greedy cat: the ravening hunger she presented with because of the diabetes died down very markedly as soon as she started on insulin.)

At the moment, Saoirse's lying in her usual night-time spot on the windowsill. She's responsive but a bit grumpy (been grumpy for the last day and a half, poor thing). I don't know whether or not to give her a little glucose solution? (I had everything ready to go in case of a hypo before I started feeding her the low carb food.)

I hear you loud and clear about the insulin. Her BG levels are up and down like yo-yos every cycle and it shows in the cycling of her mood, energy and behaviour consistently and it's taking a toll on her. I've asked about the possibility of using a different insulin but so far my enquiries have tended to be dismissed or deflected. Caninsulin seems to be the sole weapon of choice for the majority of UK vets. I wasn't given any options for her treatment.

When I spoke to the vet earlier in the week about switching to the low carb food, I asked if I should lower the insulin dose somewhat because I considered it would be a very wise precaution, especially as I have learned here and on catinfo.org that there could potentially be a very quick and significant reduction in BG levels when the switch to low carb food was being made, but the vet advised me to leave the insulin dose as it was and just work on the diet change. I've been running regular tests for the last 72 hours because I had no idea of how Saoirse would respond to the reduction in carbs (esp. as she was having trouble eating after the adverse reaction to the parasite spot-on). I actually withheld her Friday morning insulin dose because she wasn't eating properly.

Also, when I spoke to the veterinary nurse on call this morning I asked if I should just let Saoirse free feed on a little extra DM canned and a bowl of DM dry, she really didn't give me much guidance. Indeed, dietary advice seems to be very vague and generalised for the diabetes, and there is even less specificity when it comes to feeding recommendations for the pancreatitis. I'm so grateful for the information people have contributed here, and also the catinfo site.

I'm not going to give up on trying to get Saoirse onto a different insulin that is more appropriate for the feline diabetic. As you wonderful people here have advised, I'm gathering data like a thing possessed in order to build a case for a switch.
 
Update:

Tested again. Saoirse did seem a little spacy during the night. I also had a bit of a scare when Saoirse went to jump up onto the windowsill and didn't make it. I managed to get her to take some high carb treats and a little glucose solution plus some wet food. She seems OK now.

BG Tests since last insulin dose at 20:30 BST:

310 - Pre-insulin
77 - +3.5
225 - +4.75
302 - +6.5
302 - +8.25

Phoebe, thanks again for being there for us last night. I kept on my feet most of the night (very painful with an injured back) because as soon as I sat down my body wanted to shut down. The few times I did sit at the PC I kept losing consciousness. Ladyship seems OK.

I have sent texts to friends to ring me when they get the message with the idea that their calls will wake me up. I have left out canned DM and kibble DM for Saoirse. She seems pretty normal (responsive, purring when stroked, eyes expressive, pupils responsive). I can't stay vertical any more. The spirit is beyond willing, but the machinery can't take it.
 
Hello from another UK-er!

It sounds like you've had quite a night of it. You must be exhausted. (((Hugs)))

It's brilliant that you're hometesting.
Which glucose meter are you using; Alphatrak or a human meter?

Critter Mom said:
I've asked about the possibility of using a different insulin but so far my enquiries have tended to be dismissed or deflected. Caninsulin seems to be the sole weapon of choice for the majority of UK vets. I wasn't given any options for her treatment.
Click to expand...

Take heart, there are other options than Caninsulin if it isn't working for Saoirse. :smile:

Vets in the UK have to prescribe a veterinary medicine before they can prescribe anything else (ie, a medicine made for humans). There used to be other veterinary insulins available, but that stopped a few years ago, so, now we only have Caninsulin....
However, if it can be shown that the Caninsulin isn't working then the vet can, under the 'cascade system', prescribe an alternative (ie, can 'cascade' to the next medicine on the list). That will mean prescribing an insulin made for humans.
Vets vary enormously in their desire and willingness to do this. Some vets positively encourage the use of other insulins; some are reluctant to prescribe anything other than Caninsulin. (Some folks here have switched vets in order to get a more effective insulin for their cats.)

As has been mentioned, your choices include Lantus and Levemir. But we are also tremendously lucky in the UK in having Hypurin PZI available too. Hypurin PZI is a long lasting bovine protamine zinc insulin and some vets see it as the natural successor to the (now extinct) veterinary PZI.

The RVC (Royal Veterinary College) is currently running research into feline diabetic remssion, and is trialling Lantus and Hypurin PZI. We're hoping that the RVC's trial will encourage more UK vets to prescribe alternatives to Caninsulin, and to prescribe them sooner after diagnosis too.

Common reasons for people switching from Caninsulin include; very steep blood glucose drops in the first few hours of the cycle, and, lack of duration. In many cats Caninsulin only seems to have an effect for about 8 hours after which it is 'done and dusted'. That means that for 4 hours every cycle - or 8 hours out of 24 - the cat has no insulin in it's system. (Some folks have got around this by giving 3 shots a day instead of 2).

Your hometesting skills are excellent. And your data should show what the Caninsulin is, and isn't, doing. That evidence will be your best bargaining tool for persuading your vet to prescribe a different insulin.

Most folks here put their cats' blood test results onto a Google spreadsheet. They are really useful. And their colour coding makes it much easier to spot trends and patterns in the test results. If you would like to set up an SS then there are some techy folks here who can help you with that (I am not one of them! :lol: )

Oh, welcome to FDMB!

Eliz
 
[Incorrect assumptions removed by Moderator]

Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]


* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Hi Eliz. Greetings from Wiltyshire. :smile:

I've had several nights of it, unfortunately, thanks to Saoirse having the adverse reaction to the Advocate spot-on treatment on Thursday. I only had a couple of short naps over Saturday-Sunday because I was doing Saoirse's first low-carb food 24-hour curve. I'm glad I did because I had something to work with last night. Thanks oodles for the hugs: badly needed!

I wanted to home test form the get-go. The active discouragement I got from my previous vet in this respect was a significant factor in my choosing to move Saoirse to her new vets. The new practice is closer to where I live, which is a significant plus because I suffer from PTSD and agoraphobia and there's no taxi service in the small hours here. With the new vets being closer, I stand some chance of getting Saoirse to the vets on foot in an emergency (the fear for her safety would be greater than fears of the big bad world outside ...).

I'm using an AlphaTrak 2 glucometer. I know it's not the most cost-effective option but given the cognitive problems I have with the PTSD I like that it is calibrated for pusscats so I feel more reassured about the test results. This peace of mind also helps soothe my Inner Paranoiac. (What am I like??? :roll: )

Thank you so much for the background information on the rationale for prescribing Caninsulin in the UK. It helps to understand the basis for it. As for the reasons why people want to switch from Caninsulin, Saoirse's BG curves thus far have all the characteristics you mention, and she has a phase-lagged "mood curve" that follows it faithfully. It's heart-rending seeing her up and down day after day.

I have seen a couple of the members' spreadsheets and hopefully when I get my head around things a bit more I'll try to set one up. At the moment, I'm keeping a log of things on Excel. The PTSD makes it very, very difficult to assimilate new things.
 
Hi Áine,

I do so sympathise about your health issues.
I've had agoraphobia myself (am still recovering to some extent), and had it quite badly about 7 years ago. Bertie had been recently diagnosed with diabetes though, and even though I struggled even to get into the front garden usually, I did manage to get into the nearest village to get test strips for him when he was facing a hypo! His welfare was more important than my own fears, so I do understand exactly what you're saying...
(I was diagnosed with PTSD at the same time too, but disagreed with the diagnosis!).

Chin up, sweetie, ~there is every possibility that Saoirse's health will improve soon (and hopefully yours will too!)
Keeping fingers and paws crossed for you both.

Eliz
 
Hi BJM,

Thank you for the guidelines and key thresholds. The example scenarios are very helpful. I've got the HYPO protocol printed out and stuck at eye level on the kitchen door. I think I did that on my first visit to the FDMB.

So far, Saoirse has tested negative for ketones. I got my test strips and performed my first home urine test last week. The glucose level was bad, but everything else was OK.
 
Keep up the good work Aine! You are doing a great job with your kitty Saoirse. It's no wonder you are so tired. Glad you found us.

Sending you more hugs and feel better vines.

Does Saoirse's name have a special meaning? It looks very unique to me.
 
Thanks for the encouragement, Deb: so very welcome, and the hugs even more so! Have some back --> ((Deb)) :smile:

Saoirse is Irish for "Freedom." It's pronounced Seer-shuh. Her brother was Amadán (Irish for "fool"). They were born on April 1st. When I visited the rescue shelter and saw them both it was truly love at first sight.

Some lousy driver took my darling boy from me on St Patrick's Day 2003. He was only 2 weeks shy of his third birthday. I have never known anything - before or since - as excruciating as the pain of losing him (not even the pain of losing my dad). Ammie was so very loving, and so gentle. Saoirse is all the more precious to me for his loss: she is loved for two.
 
Freedom! Well, we hope to be able to get Saoirse to live up to her name and get her "free" of the insulin at some point.

How is she doing today?

Hope you got some rest too.
 
hi Aine,

(how do you pronounce your name? My bf would know, he's half Irish, but he's working solid at the moment) I love that your cat's name means Freedom. I hope you are both having a much better day today. Snap, first thing I did when I joined was print out hypo info (and then went out and bought honey!!!). When I'm feeling overwhelmed I've had a couple of rants on here, (one about stupid emergency vets when I thought Angel was having a hypo and one about my home testing skills..or lack of them! It's really helped, just writing stuff down, and everyone here is amazing.

I think when you have something like ADD or PTSD, cats can be so calming, they love us unconditionally and encourage us. I've been in some bad places emotionally at times and they have been there for me and just knowing they depend on me makes you want to be strong.

Hugs to you both, that's a cute cat in your avatar, is that Saoirse?
x
 
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