Info How Low Is Too Low?

Phenomenal post. Bookmarked and bumped. It totally confirms my very recent decision to lower my boy's usual dose (even though I loved seeing those blues and greens), after a few lower than usual numbers (and other factors as well). I know we all hope and pray for remission, but I'd rather be "safe than sorry" with my baby. Thanks again.
 
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Libby and Lucy said:
Recently I’ve seen some statements about low numbers in the Lantus/Levemir group that I believe merit further discussion.

“We intervene at 50 (some even say 40)”

If only it was that simple! The saying “every cat is different?” Very true. Also “every cycle is different.” What is the normal range for your cat? What is his onset/nadir? Is he currently surfing or dropping? Is that normal for him? What has he eaten today and when? Is that normal for him? How much food does it take to make him surf? How long does it take for that food to kick in? What if it doesn’t? If you cannot answer all of these questions, then you should think hard about whether it makes sense to wait until the cat is already very low to intervene with food.

For two of my three diabetic cats, that advice could have been very dangerous and possibly fatal. For example, if I saw Jazzy dropping fast, I knew it took a long time and a LOT of food to get her leveled out. If I waited until 50 to give a teaspoon or two of high carb, I don't think I would have been able to turn her around in time (and Jazzy was a GREAT eater, no worries about whether the food would go in). Putting on the brakes for her required a whole can of food (a 5.5 ounce can). She wasn't interested in being finessed! I thought it was because she was on a higher dose, and maybe it was, but then I saw the same thing with Kris, who was only 7 pounds and on a much lower dose. In both cases, if they were dropping and hit 100 I would start feeding high carb – not to try to prevent a reduction, but to TRY to get ahead of them so they wouldn’t crash. Kris had a pretty good bounce mechanism (not as good as Lucy's) so chances are he would have been ok, but I didn't trust Jazzy to bounce.

“Symptomatic hypos are rare (or don’t occur) above 30”

This statement needs to be thrown out with the bath water. First, I’ve seen cats that displayed hypo symptoms in the 60s. It’s not the norm, but it does happen. 40s and 50s too. Know thy cat. Second, who cares? Just because a hypo doesn’t show symptoms does not mean it’s safe. Do you really want to flirt with hypo? There was a great link on the old board (now lost) that explained the brain damage that can occur even before symptoms appear. DO NOT become complacent about low numbers, and do not let anyone tell you to be casual about them.

“So What SHOULD I do?”

Feeding the Curve seems to be a lost art. For Lucy, who responded a little more typically, finesse was more possible. We used to say “teach them how to surf.” If your cat is dropping into green and that’s new for him, or if he typically bounces to the moon as soon as he sees green, try feeding him a little food to see if you can get him to stop dropping and start surfing. For example, maybe your cat is dropping, and you get an 80 at +4 and you like that number. Wouldn’t it be great if he can stay there instead of either plunging or bouncing? Maybe he can. Give him a couple of teaspoons of low carb and retest in 30 minutes to see if maybe that got him to stay in the 80 range. If he’s still dropping, maybe try a little higher carb to see if that works. You want to “bump him onto the surfboard” and see if you can get him to stay in a nice range. Most of the time this will not work in the beginning, but keep at it. One day you will notice that your cat DOES surf. He might surf for just an hour before bouncing, but that’s progress! Next time maybe it will be 2 hours, or 4, then one day maybe he’ll just stay on that surfboard forever. Lucy did.

“What About Feeding to Prevent a Reduction?”

This is not what I’m talking about here! Instead, you are feeding proactively to try to get him to surf in nice numbers. There’s a big difference. There are people who do feed to prevent reductions, and there are reasons for it, but that is an advanced technique that is not necessary for very many cats.


Now you are saying “obviously she is too much of a scaredy cat to do Tight Regulation, we NEED low numbers.” No, we don’t. We need the cat to be in the pancreas healing range. 60-90 is a good target for most cats. The guidelines about dose reductions? It is not our GOAL to get below 50 or 40. That is a safety measure – we want to prevent that range, so if the cat hits that range we need to get them out of it and reduce the dose so they don’t do it again. And if they DO do it again, we need to get them out of it and reduce the dose so they don’t do it again. And so on.


More food for thought – “hypo unawareness”

This recent study discusses, among other things, something that we have observed here for years: “… episodes of moderate hypoglycemia are not without clinical consequences. Recurrent episodes of moderate hypoglycemia can lead to decreased sympathoadrenal responses and decreased awareness of hypoglycemia, collectively termed hypoglycemia associated autonomic failure (HAAF)7, which leads to an increased risk of more frequent and more severe episodes of hypoglycemia.”

We "teach" our cats not to bounce from low numbers by repeatedly exposing them to normal/lowish numbers. It's part of tight regulation, but it does carry a lot of responsibility.

How many times have people here commented that their cat was in the 20s or 30s and didn’t look for food? Lucy did that. Is that ok? Obviously Lucy survived the 30s, and most cats do. But would she have been just as unaware in the 20s? Or teens? What if she went low at night and didn’t wake up? I don’t know. Personally I feel that it if I push her into tightly regulated numbers that could result in hypo, it is my responsibility to be sure she stays safe. If she isn’t noticing her low numbers, then I have to notice them for her. If I cannot test 24/7 (and I don’t know about you, but I can’t stay awake 24/7 forever), then I need to prevent hypos rather than reacting to them.

Bottom line: “How Low is Too Low” is very situational and there is no single answer. All that data you have been gathering – use it! Know your cat, then do what is right for him or her. There are others here who can give advice based on their own experience or their observations, but YOU know your cat better than anyone else. Trust yourself, trust your data, and don’t become complacent.
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Thank you!!!!
 
In addition to “know they cat,” I would also add “know thy meter.”

Specifically, have a clue whether your human meter tends to run on the “lower” side or “higher” side of things.

Reading that “normal” for one person’s cat was in the 30’s or 40’s (or even 20’s) is predicated very much on that person’s meter and should not give a false sense of security to others who see that number.

My go-to meter was an old One Touch Ultra which usually read reasonably close to lab values. A 60 or 70 on that meter was pretty “normal” whereas my Relion read much lower on the same drop of blood, making “normal” for that meter more like a 40 or 50. I also had a Contour, an Asencia Elite, and others (I was a bit of a meter junkie back in the day). I never really used those other meters much, just kept them as a backup for an emergency and did some comparisons out of curiosity. My point is not that you need to know the absolute value of the BG reading, which is almost impossible, but rather that you know when a number is “safe” vs. when to be concerned.

I tested my meters on some of my non-diabetic cats to get a general feel for what “normal” was on a particular meter. If several of the non-diabetics threw me 40’s or 50’s, then that was a pretty good clue about how that meter ran and gave me a general point of reference. My OTU gave me 60’s and 70’s, so that set the bar for me. A 30 or 40 on the OTU would have (and did) send me scrambling.

Another consideration (which I almost hate to mention because I don’t want folks to stress unnecessarily) is that anemia can cause artificially inflated BG readings ... meaning that the cat’s BG is actually lower than what the meter is telling you. I mention this in the spirit of Libby’s original post, which is that we need to know thy cat, always look at the big picture and other considerations, and never become cavalier about low numbers.
 
Libby and Lucy said:
“What About Feeding to Prevent a Reduction?”

This is not what I’m talking about here! Instead, you are feeding proactively to try to get him to surf in nice numbers. There’s a big difference. There are people who do feed to prevent reductions, and there are reasons for it, but that is an advanced technique that is not necessary for very many cats.
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I would appreciate clarification on the distinction between intervening for a low blood glucose reading and preventing a reduction in insulin dosage. For instance, if my cat's glucose level is at 50 three hours after receiving insulin and I give high-carbohydrate food, am I interrupting the natural insulin cycle that may have led to a drop into the 40s, thereby preventing a reduction in the insulin dosage?

I am new to this forum but not new to feline diabetes. My cat was diagnosed over six years ago, placing him in the "long-term" diabetic category according to the forum guidelines. According to these guidelines, he must drop below 50 on three separate cycles to qualify for a reduction. However, if I provide high-carbohydrate food when he reaches 50, just above the threshold, potentially preventing him from earning that necessary reduction. I would appreciate any insights into this logic.

Is this thread simply outdated? I have been reading extensively here and consistently come across information that is still pinned or linked in the FAQs but appears to be outdated. For instance, the hypoglycemia document states that 40–60 mg/dL is low and requires food or treats to bring up the numbers to an "acceptable" level, yet the TR protocol indicates that a level of 50 is considered safe.

Have the guidelines changed since the hypo document was created? If so, why hasn't it been updated? This situation is incredibly confusing.
 
@boogerboo

There are times when you want to feed to keep a cat surfing and times when you let them earn a reduction in my opinion. We need to see a spreadsheet to see the individual cat. A cat that’s 6 years with fd is a tribute to you! Do you have a ss you would be willing to share? Would you mind posting an intro on the main/health forum and tell us about your cat?
https://felinediabetes.com/FDMB/forums/feline-health-welcome-main-forum.28/
 
boogerboo said:
I give high-carbohydrate food, am I interrupting the natural insulin cycle that may have led to a drop into the 40s, thereby preventing a reduction in the insulin dosage?
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Totally understand where you're coming from as I felt the same way. I think this is where the ECID (every cat is different) and KNOW THY CAT comes into play. The spreadsheet helps to see possible patterns and trends. Then with all the trial and error you finally really learn your own cat. I used to try so hard to get Shooter into low numbers so I could give decreases but it wasn't helping to heal his pancreas so I just decided the dose is the dose and it's better just to try to get him as stable as possible. Sometimes I feed slightly higher, sometimes higher still, sometimes just his normal low food. It just depends on the situation at that time and how he's been trending.
 
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