Hypo episode- what to do tomorrow on Easter?

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Debra and Jill (the cat)

Debra and Jill (the cat)

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Need some help here! My cat has been unregulated for many months now and runs very high with occasional very low drops. I thought over the past few weeks we were close to regulating (changed food to all tiki cat, fine tuning prozinc dose - we are at 2.5 right now) but out of the blue last night he had a hypoglycemic episode. His bg was 23 ( he tends to tolerate higher and Lower bg than a typical cat). He ate tiki cat, some of his sisters k/d dry food, I have him Karo, and he bounced back quickly. He seems ok now but I wonder what I do tomorrow? It's Easter Sunday and I won't be able to track down my vet and I know his numbers will be all over the place. Do I test his bg and give insulin if he's over 150? What do I do about the dose? I'm afraid to make him go into another hyper episode. Is there a fdmb thread anyone can point me to or some advice! Tomorrow was supposed to be a curve day and I was so hopeful we finally found a good dose dose for him but that's out the window now! At 11:30pm his bg was 23. At midnight it was 35. At 3am it was 513! I do insulin 2x a day 8am and 8pm.
 
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The high number at 3am is a bounce from the low numbers earlier. I am not familiar with Prozinc dosing so I am tagging a couple of experienced Prozinc users. Since you don't have a spreadsheet it would be helpful if you could list a bit more information...starting dose and increases, glucose numbers that you have recorded ets.



@Sue and Oliver (GA) @Mogmom and Goofus @BJM
 
Hmm, that's quite a bounce! This is just me but, when Goof does something weird like that, if I give any insulin below 150, I only give 1 unit. Whether it's right or not, I feel like when I do that it kind of levels things off and wards off another bounce. He's been running in the 150-160 range for the past couple of weeks or so then this morning he was 80. Who knows?

I wouldn't worry about the vet right now, just take some periodic tests throughout the day.
 
I agree it was a bounce after the lows up to 513 - not only his body reacting to the low by releasing more sugars but a reaction to the Karo. And the lows are a definite sign that he needs less insulin. I think the idea of giving him one unit for today (he may be down from the 513 this morning if it was an immediate bounce - he may then level off) is good.

We would be glad to help you with dosing. We suggest you put together a spreadsheet for yourself, your vet and us, so his history of levels and doses are available at a glance when you need help. If you need help with it, I can help you set it up. The instructions are here:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

One unit may not be quite enough going forward, but gradual increases if needed with careful monitoring may get him in a good place.
 
I made a spreadsheet, I hope I did this right. Cole was fine all summer, and I don't have many BGs to post. He had his first hypo episode in early Nov 2015 and most of the data is from then on. Sometimes I would just do some spot checks, just to see/curious, or if he was acting funny. Lots of full on curves though. Just talked to my vet and she said go with 1.5 units of PZI and do another curve in a week.

https://docs.google.com/spreadsheets/d/1A_7rj_XlcbL7eNtbgN08Be8MMXbzobOJ2CRpvKJW_MA/pubhtml

Would love to know your thoughts on his numbers! It looks like the Lantus was the best (that's what he was on from Feb 2015 - Nov 2015), but I think the 12 hour intervals were just too short for him and that's why he started crashing.
 
Good job on the spreadsheet. You can permanently attach it to your signature by pasting the URL into your signature. It will update each time you post.

2.5 definitely looks too high. We consider 68 the low point for AlphaTrak meters - a number to start intervening before a hypo. So it has been too low for a couple curves, and maybe the cycles between the curves. I think your high preshots are bounces and he has been careening from highs to lows and back again.

We suggest getting a preshot test before food. It's a safe way to know if the dose you are planning to give is safe. Then a number 5-7 hours after the shot should give you an idea of how low the dose is taking him and whether it needs to be adjusted. Getting those three numbers every cycle is the best way to get and keep him in safe numbers and work toward regulation.

If you'd like our help getting and keeping him in safe lower levels, post daily with your numbers. If you check out the remission thread at the top of the page, you'll see how people got their cats into remission with careful monitoring. We put together a protocol for ProZinc. It is in my signature in blue.
 
Thanks for looking at that. Cole free eats all day, but mostly when I am home in the morning and evenings (and all through the night) -- small meals, like a 2-3 tablespoons of food. He's a picky eater and I can't get him to have set mealtimes. I'm thankful when he has a steady appetite so I don't like to push it with him. My vet says when switching doses (or insulin types) that I shouldn't test his BG unless he's acting funny since the numbers will be all over while his body adjusts. I don't mind testing, he's great for me, but she doesn't want me dosing based on the BG number. She's not into tight regulation, which I would like to do if it's going to help him regulate. She's at UPenn Vet in Philly, working with one of the top diabetes specialists in the country, so I wonder -- could she be wrong?
 
We are big on believing Every Cat is Different. I have seen cats react immediately to a new dose and cats taking a week to change levels. But for me, it isn't worth taking a chance not knowing. Not every cat reacts with symptoms to low levels; we have had cats who start seizing and then the bean takes a tests and sees a dangerously low number.

For me, I went with this idea: I would not start with a dose of insulin for my child and then test in 2 weeks to see how he is doing. I treated my 4 legged "child" with the same caution. Our protocol is not tight regulation - just careful dosing based on preshot and nadir numbers. I am not so concerned that he will be too high with her methods - my concern is that he may drop too low and you won't catch it. As a vet who posts here often said "dosing without testing is like driving down the freeway with a bag over your head". Pretty good analogy. Her website is www.cat info.org. She doesn't specifically give advice for dosing with every insulin, just general advice on food and the value of home testing.
 
Hi Debra - I think you will find that many vets (even very good vets who know alot about FD) don't think cats need to be tested as frequently as we do here - I am not sure why - but I certainly feel much safer testing frequently - I've also had the experience of my cat going hypo for seemingly no reason - or having completely lower than expected test at pre shot - or the insulin lasting for 14+ hrs or like yesterday and today, only lasting for 2-3 hours :confused: for these reasons. I do not feel comfortable not testing (sorry for the double negative).
 
Hey Debra! As Sue said, I would NEVER dose a child with insulin without testing. I also wouldn't dose myself without testing. The only way to see how the insulin is actually working is to get tests each day. I can tell you from my experience, my cat was in higher numbers most days...then one day out of the blue, she was at like a 90 preshot. If I hadn't been testing before shooting, I would have blindly shot a dose, gone to work, and almost certainly come home to find her dead. Thank heavens I was testing.

Since ProZinc works based on nadir AND preshot values, there is no way we can work on getting your kitty regulated without that data. We won't know what's happening, so we can't figure out what a good dose is.

I am concerned that if you don't test, you'll end up with a hypo episode. Some cats don't show signs of it physically...but it can still be very dangerous. Without testing, you might not catch it. Especially since he's had hypo episodes, he'll probably be even more sensitive to insulin.

We definitely want to help you help your kitty. Testing is one of the most important ways we can do that.
 
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I've been testing now each day before the insulin and keeping up with my spreadsheet. If anyone has time to take a look and let me know your thoughts, please do! I see a new internal medicine specialist on Monday who I am hoping has some other ideas on how to get Cole's BG under control. Thanks, all!
 
Hi Debra - not a ProZinc user I just saw Cole's picture and was smitten - he's so beautiful!

DebraM said:
I don't mind testing, he's great for me, but she doesn't want me dosing based on the BG number. She's not into tight regulation, which I would like to do if it's going to help him regulate. She's at UPenn Vet in Philly, working with one of the top diabetes specialists in the country, so I wonder -- could she be wrong?
Click to expand...

I respectfully disagree with your vet - not about the Tight Regulation (given Cole's a grazer and you live in a multi-cat household, he's likely challenging candidate -- at least given my experience with Lantus), but about the not dosing based on BG. My own vet didn't discourage testing, but he did not strongly suggest it in my initial visit, either. In a more candid discussion with him after a few months, when I showed him my spreadsheet and Genghis' improvement, he admitted that so many of his clients were put off by the idea (imagine!) and he wanted to at least give a cat a chance rather than scare off the owners, so he never began with recommending home testing. I had a similar experience that Rachel talked about and I'm sure if I hadn't been testing, the combination of diet change and insulin would have sent my girl into hypo-space. TR is a protocol that demands testing, certainly, but like others have said, insulin in any type of regime should not ever be administered without knowing where you stand. Not in a human, not in a cat. My dad is a long term Type II diabetic and a retired physician who wholeheartedly agreed with the testing approach advocated by this Board.

Anyway, if you're like me, you will love the tale that testing tells. There are folks on this board who can read spreadsheets like an art-form and they will help you immensely - their combined experience is mind-boggling! You yourself will learn the patterns and the dance between food and insulin that are particular to Cole (as Sue says, ECID!!). You don't have to test to the extent I did (oh Genghis, you were so patient for me) but you may enjoy having the numbers tell you a fuller story than Cole is able, get guidance on his dose from the folks here so that you can get Cole off the roller coaster of highs and lows.

I know it's hard to challenge a vet - you want to keep a good relationship and I can see you only want what is best for Cole. I switched to Lantus without consulting my vet and initially I felt a little guilty, but once the results showed my cat's improvement, it was a hard decision for anyone to argue with. I was lucky that my vet is so open-minded and his concern was not being right, but that my cat be well. Anyway, I know it's hard to tell your vet that you "saw it on the internet" and yes, there is a lot of junk out there. But this site isn't just a bunch of crazy cat ladies with wacky ideas. Sorry if I am sounding preachy but I know there is no way I would ever have gotten my cat regulated and eventually off insulin without their guidance. They will sit with you through hypo events, pore over your spreadsheet with loving care, be there whenever you need them. I've never met a more dedicated group of folks.

I wish you the best of luck with your beautiful Cole.
 
We went to see a new vet yesterday for a second opinion and, of course, he has a differing opinion on what to do (which is fine since what we are doing isn't working at all). Looking at my spreadsheet, he said something was just not right -- the numbers aren't making sense. He ran a ton of labs on Cole and left me a message today that his fructosamine is normal which means all the super-high readings I have been getting must be wrong -- either my meter is off or Cole is getting really stressed at pokey time (he doesn't seem it to me, but it's a possibility). The vet is thinking about switching us to from ProZinc to Levemir and having me get a new meter. So the questions now is -- which new meter? I need one that takes a tiny bit of blood, which is why I like the Alphatrax. Any suggestions?
 
That's really interesting because Murphy's fructosamine a few weeks back was normal a well, and he' all over the place You are lucky - I want to switch to Levemir but my vet, since his fructosmaine is normal, says no Maybe your vet just means getting another alpha trak - you should do a reading at the vets with your meter and compare to what your vet gets on his/hers
 
Debra, like Carol & Murphy, there was someone here on the board whose cat was diagnosed IAA just a while ago and her cat, Menace, had fructosamine results return "normal" as well, despite BG readings that were consistently high. I'm not a vet, but from anecdotal evidence I've seen here, fructosamine results aren't always indicative of controlled diabetes. Is Cole exhibiting the classic signs of diabetes despite the results? Drinking lots, peeing lots, ravenous appetite and weight change? You sound very intuitive and it seems to me that you know Cole well. If you don't think he's stressed at pokey time, he probably isn't.

That said, checking the meter is a good idea -- have you got control solution for your current meter? That should tell you if the readings are off. I'm not sure how quickly you could get it, but every time I thought readings were wonky or I started a new vial of strips, I would do one reading with the control solution and have some peace of mind.

I have the Contour Next meter and I really like it, especially because it's back lit and easier to read in low light conditions. It uses more blood than the AT meter, but way less than the one meter I started with, plus it has "second chance" strips that let you take more than one run at a reading if you mess up - with strips about $1 a piece here in Canada it was a great selling point. The Freestyle meter also uses a tiny drop of blood but the "side load" strips and tiny meter just didn't fit well for me - your mileage may vary!

Hope that helps.
 
DebraM said:
We went to see a new vet yesterday for a second opinion and, of course, he has a differing opinion on what to do (which is fine since what we are doing isn't working at all). Looking at my spreadsheet, he said something was just not right -- the numbers aren't making sense. He ran a ton of labs on Cole and left me a message today that his fructosamine is normal which means all the super-high readings I have been getting must be wrong -- either my meter is off or Cole is getting really stressed at pokey time (he doesn't seem it to me, but it's a possibility). The vet is thinking about switching us to from ProZinc to Levemir and having me get a new meter. So the questions now is -- which new meter? I need one that takes a tiny bit of blood, which is why I like the Alphatrax. Any suggestions?
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The fructosamine test will show an average of what the numbers have been at for a 2 weeks period. If Cole has had as many lower numbers as higher numbers then the average may show as normal while in reality the levels are not regulated. Daily testing shows a much clearer picture of what is happening.
 
"
What fructosamine and Ghb tests can do
The "plus" side of fructosamine and Ghb testing is learning how well overall glucose control has been over the past few weeks. The "minus" side is that they can't identify any possible problems. In short, they can tell you that you've gone wrong, but they can't tell you where. Worse, it's possible to get a good fructosamine result (average BG) while having very poor regulation (alternating highs and lows.) Fructosamine and Ghb tests are not intended to replace blood glucose curves, but to supplement them."

http://petdiabetes.wikia.com/wiki/Fructosamine
 
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Carol & Murphy said:
one would think :arghh:
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You certainly do enough testing that the vet would have to see the ups and downs. It is like you run a mini curve on a regular basis. In the posting above it says:

"Fructosamine and Ghb tests are not intended to replace blood glucose curves, but to supplement them."
 
Carol, have you asked your vet why the fructosamine is normal and the numbers you get are not? Mary Ann explains it perfectly, but I am thinking that if you ask your vet and he has to verbalize it, he may see that what he is saying is wrong! That's got t be frustrating. I was lucky...food was our only sticking point. My vet encouraged home testing with a human meter...and when I brought my SS in she was like "well you've been handling this perfectly!".

I'd say try to bring your SS to the vet and have a real conversation. If he won't listen...can you find a new vet? Might be your best option.
 
DebraM said:
We went to see a new vet yesterday for a second opinion and, of course, he has a differing opinion on what to do (which is fine since what we are doing isn't working at all). Looking at my spreadsheet, he said something was just not right -- the numbers aren't making sense. He ran a ton of labs on Cole and left me a message today that his fructosamine is normal which means all the super-high readings I have been getting must be wrong -- either my meter is off or Cole is getting really stressed at pokey time (he doesn't seem it to me, but it's a possibility). The vet is thinking about switching us to from ProZinc to Levemir and having me get a new meter. So the questions now is -- which new meter? I need one that takes a tiny bit of blood, which is why I like the Alphatrax. Any suggestions?
Click to expand...

I am wondering if the dose is just too low and the insulin peters out by preshot time. It's something we often see. The insulin is working; it just doesn't last the full 12 hours. The fructosamine makes sense to me - he is in low ranges the majority of the time. The fructosamine is an average over time. So averaging mostly lows and a few times can get you a good looking average.

It cdefinitely can be bouncing also. The dose on 4/4 kept him in lower ranges for preshots. I like it. Maybe keep with that dose in that range and try 1.25 when he is in the reds.

It is early to switch but Levemir could get him flatter cycles.
 
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