Hypo twice in three days

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Brigitte & Talley

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Talley went hypoglycemic three nights ago testing at 40 mg/dL six hours after feeding. He ate that night fully, and I'm positive I didn't give him the wrong amount... I did a curve and went to my vet and he suggested I reduce his 3u of Lantus to 2u. That night (last night) I gave him 2u of Lantus.

For one day, his curve on 2u of Lantus:

Preshot - 260
Peak - 135
Next Preshot - 315

So this morning I gave him 2u again and he's acted normal for the day. Despite his numbers being a little high, I stuck with 2u because I read that cats can be more sensitive to insulin after a hypoglycemic episode. This night, before feeding, he tested 40 mg/dL with no visible symptoms. That was about 40 minutes ago. I gave him 2 CC of Karo syrup on top of his meal and obviously did not inject him.

Tonight's 40 mg/dL test was on a new box of strips, but I tested him with four different strips and they all read 35-40 mg/dL. A quick test on myself came up with a regular number for human BG levels on that tester and strip pack.

That's the backstory. So now my questions:

-- What could be causing his numbers to fluctuate so dramatically? I'm positive he's eating (I'm currently on summer break so I'm with him 24/7). I haven't changed his diet at all.
-- Could it be remission? What's an average number I should expect if he does go into remission?

I'm going slightly crazy here. He's not showing any signs of hypoglycemia tonight but I'm staying up with him anyway. His episode 3 nights ago happened 6 hours after I fed him. Now he's in hypo range at feeding time on less insulin but the same food. I can't afford an emergency vet let alone another vet visit. This forum is my last hope for some answers or advice.

Thank you so much,
Brigitte

EDIT 1:

Thursday, August 12, 2010 - 10:30 reading: 67 mg/dL
 
anything below 40 is usually time for a dose crease, in your case a dose decrease. i'll get some lantus folks over here to take a look k?
 
Thank you. I'm going to keep posting his numbers as a means of keeping me sane and keeping readers informed of his current status. I'm glad it's climbing.
 
Welcome to FDMB.

Do you have any more blood glucose (BG) test data from the last few days? It sounds like you're home testing which is great. It's hard to try to draw any conclusions based on just a few numbers.

One likely possibility is that Talley drops low during the cycle and then his liver panics, dumps glucose into his system, and then you see high numbers. You give a dose of insulin, numbers drop, Talley's liver panics and the cycle continues. But, this is not definitive without more information.

Remission isn't based on one number nor is there an "average" number. With Lantus, we bring a cat's dose down to what amounts to a microdose with numbers staying in a normal range until the cat is off insulin for a period of two weeks. At that point, the cat is considered diet controlled/in remission.
 
I don't have these entered into excel yet so bare with me.

Tues. 8/10/10
9:30 AM - 111 - Skipped Injection, this was the morning after the hypo event; Preshot
12:20 PM - 220
3:30 PM - 255
6:30 PM - 280
9:30 PM - 263 - Went down without insulin? Preshot

Wed. 8/11/10
12:30 AM - 241

[interval of sleep for the first time in 24 hours]

9:30 AM - 250 - 2u Lantus given per vet recommendation; Preshot
12:30 PM - 135
3:30 PM - 155
9:30 PM - 311 - 2u Lantus given; Preshot

Thurs. 8/12/10

[Can't remember morning's number. Forgot to write it in the journal and the recalibration of the tester wiped its memory :( I know it was in the high 200s. 2u Lantus given ]

9:30 PM - 40 - New test strip packet on ReliOn Ultima. Tested four times. Showing no symptoms. Given 2 CC of Karo Syrup, 1 TSP Dietary Supplement; No injection given
10:30 PM - 67
11:30 PM - 90
12:30 AM - 81
1:30 AM - 83

I swear he's going to bite me. I'm bribing him with treats now.
 
Briggit, i'm not a lantus user but if i'm understanding your #'s correctly than you definetly need a dose reduction.
are you familiar with the lantus board?
look up ISG insulin support group and hit on lantus and introduce yourself. considering the late hour there might not be a big response but there is always someone there.
i'll stay with you here as long as i can. you are probably out of the woods but that # at +12 definetly has a meaning.
so go on over to lantus. say Help! in your intro to get more atten.
 
you might want to feed some high carb canned if you have any...the karo acts quickly but does'nt last long. the food lasts much longer.
 
I took your advice and made a post over on the Lantus forums. Here's hoping.

As for food, I'm thinking I'm gonna go break open the other half of his can I was saving for breakfast. No sense in not letting him pig out at the moment, within a limit. About to do his next test if he stops fidgeting. He always twitches right after I prick his ear so the little blood droplet splatters onto my clothes and I have to try again...

C'mere Talley! Bleedin' time!

EDIT: 90 mg/dL. Adding it to my chart on my last post
 
i'm guessing you don't have any hugh carb canned? the low carb alone is'nt really enough. maybe you could mix just a little karo or whatever syrup your using into it. the idea is longevity. in your case tomorow go out and get some gravy food high in carbs. have you seen janet and binky's food chart?
 
Ah. I failed to mention that after he tested 40 on his preshot, the can I mentioned in my last post IS a high carb can. I have other cats that eat regular food so finding one was easy. I apologize for the misunderstanding.
 
bridgett i just looked at your profile, i see you've been at this since last year. why are'nt you a regular in lantus after all this time? i thought you were a newbie :-D it would really be helpful if you had that ss and checked in with them...probably better advise than your vet.
 
We kept a supply of Fancy Feast Elegant Medleys on hand for this type of situation. The shredded types run around 10-12% calories from carbs and the Souffle flavors are around 15%. We did also have a 20% floating around and some kibble. I never ended up giving him Karo syrup, but if he tested low (under 50) or exhibited symptoms despite testing something that should be ok (60-80 or so) we'd give him some of the higher carb moist food with perhaps a few kibble on top and then retest every 1/2 - 1 hour until he was doing ok.

I think you should consider the possibility of another dose decrease. When Yittle went into diet-controlled remission the dose decreases came pretty quickly after each other. He'd take a few days or a week or so to settle into each new dose and then boom - hypo again and we'd drop down another notch until he was off the insulin.
 
That sounds like what's happening. He just ate a Medley so we think alike :P

He seems stable. About to do another test. I'm fairly certain he wasn't hypo this time since he showed no symptoms. Three days ago he had 80% of the listed symptoms. Still, he was borderline. I'll try to keep a medley on hand for situations like this to tip his numbers into a safer zone when he's this low. Poor kitty. So many tests in the last few days. His ear must be so sore. I'll continue to check him each mealtime until I've found a good dose, then go back to my random spot checks.

EDIT: 83 mg/dL on this recent one.

I wonder if I can stay awake for a 2:30 AM test... energy.... slowly... draining.
 
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