? Hypo Today - Need advice for tonight

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HyperJMA

HyperJMA

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Hey Everyone,
I have a previous post over in the main Health Forum. Mister Mistopheles had a hypo today. Of course, I'm now a mess!!!

The problem we now have run into is that we were going to rely on our monitor's history records to create the spreadsheet, but it is giving us weird read outs.

I have written down everything that my monitor gave me in the "Sheet 3" of the SS link. And I am updating today as well.

I think I really screwed up this morning. Previously we were doing the "between 150-220" give 1 unit and above 200 give 2 or 2.5 units. I guess I just got complacent and thought that he was on a "rising trend" this morning and gave the 2.5.

What do you suggest we do for tonight? We have a checkup tomorrow anyways with the vet, so I will mention this to her and get her advice. Problem is, she isn't really an expert in diabetes. She's just a general vet.
 
Hi Jess,

I can't make out your ss, so it is advised to update that as soon as you can ;) Tab 3 isn't really clear to me, but I've read your other thread and it makes some sense.

HyperJMA said:
reviously we were doing the "between 150-220" give 1 unit and above 200 give 2 or 2.5 units.
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I don't know if a sliding scale is something that you've done for a longer period off time? But it is best to stay on the same dose for at least 3 cycles and if nothing changes you can always increase a dose.
If the numbers drop too low than you can for sure decrease the dose, that is not a problem.

If Mr.M were my kitty I would decrease the dose to 2U instead of 2.5U just to be on the safe side.
Do you know what caused the hypo? Was it the BG of 159? or didn't Mr.M eat well ? It could have been anything ofcourse but sometimes you know what caused it.
If Baco was around those numbers I wouldn't give a full dose because "the guidelines" for when you just start out with Prozinc is to not shoot below 200, and if you've got some more data than you can decrease that 200 to 150.
So 159 is a number that is really close to 150, and in that case, if Mr.M were mine, I would've gone with a less than 2.5U.

What does your gut tell you Jess? What do you feel comfortable with?
 
Can you update your spreadsheet so we can see how she has been doing the last few days. I'm with Ruby - I would go down in dose but I am not sure how much until I see some recent numbers.
 
Ruby&Baco said:
Hi Jess,

I can't make out your ss, so it is advised to update that as soon as you can ;) Tab 3 isn't really clear to me, but I've read your other thread and it makes some sense.


I don't know if a sliding scale is something that you've done for a longer period off time? But it is best to stay on the same dose for at least 3 cycles and if nothing changes you can always increase a dose.
If the numbers drop too low than you can for sure decrease the dose, that is not a problem.

If Mr.M were my kitty I would decrease the dose to 2U instead of 2.5U just to be on the safe side.
Do you know what caused the hypo? Was it the BG of 159? or didn't Mr.M eat well ? It could have been anything ofcourse but sometimes you know what caused it.
If Baco was around those numbers I wouldn't give a full dose because "the guidelines" for when you just start out with Prozinc is to not shoot below 200, and if you've got some more data than you can decrease that 200 to 150.
So 159 is a number that is really close to 150, and in that case, if Mr.M were mine, I would've gone with a less than 2.5U.

What does your gut tell you Jess? What do you feel comfortable with?
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Hi! Thanks for the insight! (I had to be out for the evening so hubby took over around 530 pm)
"Do you know what caused the hypo? Was it the BG of 159? or didn't Mr.M eat well ?" --> I think it was both. In the past, we have tried a constant dose for many cycles. When he was at 2 units his BG was too high, but when he was at 3 units sometimes we would get a no shoot number and he would miss his nighttime dose. Also --- he started having 'mountain' curves instead of 'happy face' curves when we monitor the glucose for a period of time. Also, in the past when he is below 200, we typically would monitor him to see if he was trending up or down, and most times he would trend up and we would shoot him when he was around 189 or so. I don't really know exactly why we didn't have some sort of alarm in our head this morning.... I think it happened out of habit. We just assumed it would keep rising, especially once he ate his Kidney Special Diet Kibble. Around 1 pm, I gave Mr about 1/8 cup of Stella and Chewy's Chicken Chicken and he gobbled that up. Then about 30 minutes later he went to the wet food dishes and nibbled on them but didn't eat anything. So, I thought he was being fussy, and decided to wait a little to then give him some more Chicken Chicken. And that's when I tested him and found the hypo. I think his body was telling him to eat, but he really hates wet food so he decided not to. I just don't know what to do now, because we can't leave the Stella and Chewy's out for more than 2-3 hours because it's raw. But he is normally a grazer, and won't finish a meal right away. I feel so guilty.

At this point he has been holding steady around 242. Hubby gave him a dose of 2 units at 8:30 pm as well as a few TBSP of grilled chicken. We are going to offer him more now.



~~J~~
 
If I am reading this right, he was 154 @ 7:15 AM, 158 @ 7:45 am, and then you gave 2.5 units @ 8:45 AM?

I'm not a dosing expert yet, but I believe that is a really high dose, for a really low pre-shot number. Personally, at this point I wouldn't shoot at all below 200, and if he was close to 200, it would be a smaller dose compared to recent doses.
 
Shorty said:
If I am reading this right, he was 154 @ 7:15 AM, 158 @ 7:45 am, and then you gave 2.5 units @ 8:45 AM?

I'm not a dosing expert yet, but I believe that is a really high dose, for a really low pre-shot number. Personally, at this point I wouldn't shoot at all below 200, and if he was close to 200, it would be a smaller dose compared to recent doses.
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Yes, that would be correct. I think we just assumed it would keep rising, as it has in the past. We won't be making that mistake again.

~~J~~
 
Well, I hope you guys, and Mr M get a good nights sleep. Give him lots of lovings, and just keep going. I've known plenty of humans with diabetes who mess up their own shots or doses, even knowing how they feel and exactly what is going on. I can think of several times when my college roommate, who had been diabetic for 10 years at that point, either forgot a shot, or double shot (dose before dinner, and another dose after dinner!) As an parent of a kitty, we're all bound to mess up just as often.
 
The most important thing is you caught it and we're able to keep him in safe numbers with a little food. And you learned to make sure the numbers are rising to keep Mr M safe in the future :cat: We all do the best we can for our kitties, your doing great by your boy! :bighug:
 
He's back down to 185 at +3 ---- I know I'm being extra sensitive --- but I'm freaking out now.
B is going to wake up around +6 to take BG again.

When is Nadir again?
 
He hasn't dropped dramatically since his preshot, he's still safely away from low numbers, and he's only really dropped about 60pts in 3 hours... Don't panic quite yet, but it never hurts to keep an eye on his numbers after today's drop :bighug:
 
Hi! Here's an update -- I'm still really scared to even go to sleep.

So he is recovering from a hypo this afternoon.
8:30 pm BG was 242, gave grilled chicken from the grill, gave 2 units Prozinc
9:30 pm - BG 248, gave Stella and Chewy's chicken chicken (1/8 cup)
11 pm - BG 185, offered dry kibble, didnt want it
12 midnight - BG 141 - nibble of dry kibble, just wanted to be left alone
Should I stay up to test again at 1 am? Is this dropping too quickly?
 
It was completely normal to be hyper sensitive and hyper vigilant after his hypo. His numbers last night were very nice. A drop of 50% at nadir is expected and a nice drop. The time to worry is when you get a big drop early (+2/3) and when he nears 68, any time in the cycle. As you see lower ranges but they stay in safe numbers, you'll get a feel for what looks good and when to watch more carefully.

I would save the kibble for below 68. And even then, I'd suggest a little gravy off a gravies high carb food instead. They tend to bring up the levels faster and last longer. It is good to have some gravy Fancy Feast varieties in your hypo kit.
 
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Sue and Oliver (GA) said:
It was completely normal to be hyper sensitive and hyper vigilant after his hypo. His numbers last night were very nice. A drop of 50% at nadir is expected and a nice drop. The time to worry is when you get a big drop early (+2/3) and when he nears 50, any time in the cycle. As you see lower ranges but they stay in safe numbers, you'll get a feel for what looks good and when to watch more carefully.

I would save the kibble for below 50. And even then, I'd suggest a little gravy off a gravies high carb food instead.m That tends to bring up the levels faster and last longer. It is good to have some gravy Fancy Feast varieties in your hypo kit.
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Sue if I remember correctly from earlier posts the Advocate meter she is using is a pet meter. That would mean that the "hypo watch alert" number would be 68 rather than 50.
 
Thanks everyone!

This morning he is well, sleeping in the back door in the sun --- his favorite place to be.
mister in sun july 13 2016.jpg


I've taken his BG twice this morning and hubby and I are going to have a new strategy ---- We really think that because we were withholding the dry food that it became a "commodity" in his mind --- that when we gave it to him he had to eat all of it. Basically, he's a kibble addict with kidney failure and won't eat the kidney wet food. Recently we found Stella and Chewy's Chicken Chicken and he seems to like that. We are purchasing EZ Complete also, to see if we can transition him easier to a wet food.... but back to our strategy

---> Last night we left the dry food down, like we have for the past 18 years, and he only visited the dish once! This morning when I gave him his shot I gave him some Stella and Chewy's and he ate it and loved it!

---> What I found alarming yesterday was that before his really low numbers, Mister walked over to the wet food in the food area, sniffed the wet food, and walked away. But, when I gave him dry food, he at it immediately. Our conclusion is that he would rather eat dry food occasionally, perhaps when he is low BG.

---> Since we had taken it away and made it such a treat he will eat it immediately right now.

---> Our hope is that we will start creating such yummy wet food and home made food that he will only go to the dry food if he were to experience low BG levels again. As soon as we made the dry food readily available last night he started saying "whatever, I'll come back to it later if I want it..." and just walked away.

Does that make any sense?

UPDATE ---> Mister has a regularly scheduled vet appointment today at 11 am EST. Will post an update after the visit. He is going to get blood work done to see how the fluids are helping and also if the kidney deterioration is slowed at all.
 
He looks comfy, Jess. I hope you and Dh are feeling better today too. M

I'd encourage you to dump the kibble as soon as you can. Though dry food can bring up lowering bg levels, gravy off high carb food works better. And even a few pieces of kibble during a regular cycle can raise the levels quite a bit. If you can eliminate dry high carb food from the diet and the house, you are in better shape. Stella and Chewy's is a great substitute.
 
Sue and Oliver (GA) said:
He looks comfy, Jess. I hope you and Dh are feeling better today too. M

I'd encourage you to dump the kibble as soon as you can. Though dry food can bring up lowering bg levels, gravy off high carb food works better. And even a few pieces of kibble during a regular cycle can raise the levels quite a bit. If you can eliminate dry high carb food from the diet and the house, you are in better shape. Stella and Chewy's is a great substitute.
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Unfortunately our civvie cat (Nala) won't eat wet food either. And we are worried about the phosphorus levels in the S&C. (Our sugar cat has kidney insufficiency/failure). We have an appt with our vet in ~30 minutes and hopefully will see what the phos levels are as well as the SDMA, Crea, and BUN. We can go from there.

When it comes to eating --- a cat eating kibble is better than a cat going on a hunger strike and eating nothing.
 
Dry food does bring up BG levels...but it really can take awhile, so during a hypo, we encourage gravy off high carb food (doesn't fill them up as much either, since they aren't eating as much...so you can give more if needed!). Just a thought.

It's true, you've got to make sure the cats do eat! But I'm with Sue...if you can keep the diabetic away from kibble, it will surely help!
 
The vet thinks we are micromanaging him too much and possibly stressing him out --- Which might lead to him not eating. Hubby and I are going to try to take a step back and to stop forcing him to eat things he doesn't like. The dry food has been sitting there all day and he hasn't visited it once. But I'm offering him a mixture of foods around 3 or 4 pm.

How far in advance should we give him food, so that it doesn't effect his BG when we measure it?
 
Hi Jess, I wanted to let you know that there is a phosphus binder that you can order and add to the wet foods that aren't necessary lower in phos. So when you find a low carb wet food that Mister Mistopheles will eat, you won't have to worry about the phos levels. Let me see if I can find out where to get it for you and I will post here.
 
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