Low BGs, what action to take

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toothless

Member Since 2020
Hi everyone, recent new lurker, first-time poster. Toothless is on ProZinc and recently was upped to 2.0 units after we saw little in the way of results from 1.0 and 1.5. Now, it seems that 2.0 is too much. See his spreadsheet below. It's not exactly the same as the template available here, as I couldn't get it open to use. I made my own that is pretty similar, and we record in mmol and convert to dl on another tab.

My question is about his recent numbers below Feb 14th. We do our AM and PM shots at ~9:15-9:30, and have to go to work for his nadir most days. Lately when able, testing at +2, +3, +8, and occasionally +6 we're seeing numbers indicate that his nadir is in the 2mmol range (38-45) and are concerned. He has little to no clinical symptoms of diabetes now (thirst, urinating; ravenous hunger has always been a thing; weight loss seems to be stabilising), and does not seem lethargic except after a big meal (which includes insulin). If we offer him more food when he looks lethargic, he picks right back up... so I assume he is just actually sleeping.

We had taken him off dry food (per sheet notes) almost entirely because it seemed to spike him every time he got even a tiny bit. We're now using dry food to try to guide him through lows, but even a (comparatively) high dose of dry food does not seem to spike him anymore (see today's readings).

Generally when his BG was very high we were 100% wet food, now dry food seems required to keep his BG high enough! Should we lower or skip his dose? What does this pattern mean? Vet does not agree with home testing, but this data is very important to us and tells a critical story. How worried should we be about these low numbers and hypo potential? Thanks in advance.

https://docs.google.com/spreadsheets/d/1XDIiDh3zrMEZTy-Wbs6CD8y3kNl6DG9JVe6A3QOgsP4/edit?usp=sharing
 
Dry food takes longer to have an impact on the BG (blood glucose) levels, because it takes longer to break down in the stomach.

Canned cat food is available in low carb, medium carb and high carb options. Depends on what country you live in.
Would you please tell us what country you live in?

How did you and Toothless find us?
Would you share your first name with us please?
 
Those bright lime green numbers you have on your SS (spreadsheet)? Those are definitely telling us that Toothless needs a dose reduction in the Prozinc insulin. ASAP.

We also STRONGLY suggest you test before every insulin shot. We call it the pre-shot test. That tells you if the BG (blood glucose) levels are high enough to give insulin in the first place. Once you give the insulin, there is no way to take it back out again.

Dose looks too high to me. Both 2/18 and 2/23 scream at me to do a dose reduction. We adjust doses in 0.25u increments. Changing the diet can have major impacts on the BG levels, as you have found out.

Also, without a few night cycle tests, it's difficult to know if Toothless is dropping too low at night. Many cats do, since they are more active then. We suggest you try to get at least 1 or 2 tests in during the PMPS cycle. Without that night cycle testing, you are missing half your data as Sienne would say.
toothless said:
Should we lower or skip his dose? What does this pattern mean? Vet does not agree with home testing, but this data is very important to us and tells a critical story. How worried should we be about these low numbers and hypo potential?
Click to expand...
Definitely lower the dose, to what I can't be sure.

We consider home testing to be critical to seeing how your cat is doing on the insulin.
Low numbers like those bright lime greens? Those are hypoglycemic territory.
I'd be pretty worried if this were my cat.

Do you have a hypo toolkit? jojo and bunny's HYPO TOOL BOX
Do you have the thread that talks about hypo symptoms?How to treat HYPOS - THEY CAN KILL! Print this Out!!

Strongly suggest you print a copy and read it thoroughly.

Be right back with more info. On today's BG readings.
 
3.7 mmol = 67 mg/dL
3.1 mmol = 55.8 mg/dL

Way too low again.
Suggest you cut the dose in half or even down to 0.5U for now.
Or skip the shot for tonight. Personally, I'd skip and test for ketones in the urine.

The insulin dose may need to be even lower than the 0.5U dose.
Need more data to really tell.
When is you next pre-shot test due? How many hours from now?
 
toothless said:
We do our AM and PM shots at ~9:15-9:30
Click to expand...
No idea where in the world you live, so I have no idea when 9:15 or 9:30 happens.

We express hours in + time format.
AMPS is AM or morning pre-shot.
Hours are counted after the shot of insulin.
So +1 is 1 hour after insulin, +2 is 2 hours after insulin, etc.

How many hours has it been since the last shot of insulin?
 
Just came in to agree wholeheartedly with Deb. Dose needs to be lowered ASAP. With those super low numbers, please take a BGL test before injection and skip or reduce if his level is too low.
 
Deb & Wink said:
No idea where in the world you live, so I have no idea when 9:15 or 9:30 happens.

We express hours in + time format.
AMPS is AM or morning pre-shot.
Hours are counted after the shot of insulin.
So +1 is 1 hour after insulin, +2 is 2 hours after insulin, etc.

How many hours has it been since the last shot of insulin?
Click to expand...

Hi, thanks for the replies. Eastern time zone (Canada), however I did mention in my initial comment the '+' times for reference, and they are on the spreadsheet as well. I only mentioned the time in the context of having to go to work.

We have been doing the AM & PM numbers more reliably since we caught a couple low numbers, I just have not added this AM to the spreadsheet. PM tonight is in ~2 hours. It is 7pm here.

He always happily eats without fail, so we give him the shot while he's distracted by eating. I found the message board from researching his condition online. The vet has given us mixed advice about what to do when numbers are low. First said don't give the shot if number is below x. We delayed and called for advice and he lectured "the shot needs to be at the same time every day, you can't delay."

I have read all the hypo stuff and even when he tests very low (we use a contour next), his behaviour always seems normal (of course, we're not always home). We've been getting so much conflicting advice, but I know these numbers are lower than they should be and just looking for a next step. You mentioned ketones--wouldn't ketones only be present with high BG? Not low?

Our syringes do not seem large enough to reliably change by a quarter unit. I am thinking we'll move back to 1.5 going forward and see how that goes, or is that not enough? We were planning to skip his evening shot tonight before seeking advice here.
 
Would you update your user profile a bit please? Adding country would be nice to see, as well as seeing timezone in your profile.

Then, info in the signature is very helpful. Upper right, click on your user name and add some data.

While you are doing that, I'll work on responding to the rest of your question.
 
Prozinc insulin normally requires a U40 insulin syringe. You have to 'guesstimate' those smaller doses.

There is also a conversion chart where you can use U100 insulin syringes to measure out a U40 insulin. Conversion is U40 insulin dose times 2.5.

Chart is here. http://www.felinediabetes.com/insulin-conversions.htm

If you want to use U100 insulin syringes with Prozinc, you want to look for U100, 3/10 cc volume, (30 units max capacity), with 1/2 unit markings on the barrel. There are no insulin syringes that have 1/4 unit markings.

Your choice as to the dose. Are you around to monitor closely tonight if you give the 1.5U dose? Skipping the dose is also another option. Or giving a "token" dose of 15-25 % of the normal dose is option number 3.

Do you have medium carb (MC) and high carb (HC) wet food on hand? Some sort of simple sugar, corn syrup, pancake syrup, maple syrup, honey?
 
Deb & Wink said:
Prozinc insulin normally requires a U40 insulin syringe. You have to 'guesstimate' those smaller doses.

There is also a conversion chart where you can use U100 insulin syringes to measure out a U40 insulin. Conversion is U40 insulin dose times 2.5.

Chart is here. http://www.felinediabetes.com/insulin-conversions.htm

If you want to use U100 insulin syringes with Prozinc, you want to look for U100, 3/10 cc volume, (30 units max capacity), with 1/2 unit markings on the barrel. There are no insulin syringes that have 1/4 unit markings.

Your choice as to the dose. Are you around to monitor closely tonight if you give the 1.5U dose? Skipping the dose is also another option. Or giving a "token" dose of 15-25 % of the normal dose is option number 3.

Do you have medium carb (MC) and high carb (HC) wet food on hand? Some sort of simple sugar, corn syrup, pancake syrup, maple syrup, honey?
Click to expand...

Yes, we have the U40s for now. We can monitor tonight for sure, it's during the work day that is harder. We have honey, maple syrup, etc. on hand plus Purina Diatetic Management Dry & Wet (both low carb I believe), plus some of the old wet food we used to feed which I'll have to check on for carb content.

When do you recommend skipping doses vs dialing back? Is skipping only for when the dose can't get any smaller?
 
toothless said:
The vet has given us mixed advice about what to do when numbers are low. First said don't give the shot if number is below x. We delayed and called for advice and he lectured "the shot needs to be at the same time every day, you can't delay."
Click to expand...
Yes, that happens a lot. The conflicting advice.

No, Prozinc insulin being an in-and-out insulin does have a bit of flexibility in the dosing. Up to an hour if you need to stall and you can still stay on track for your next shot time. Yes, it's best to space the insulin shots 12 hours apart, but sometimes there are delays. You don't want to be changing up your shot times with every cycle. But there is a little bit of flexibility with Prozinc.

A test at +11 can be very helpful for Prozinc users, as some cats BG's rise quite a bit between the +11 and the pre-shot test. ECID Every Cat is Different.

We have more experience with diabetes than most vets, even though we are only lay people. The common thread among members here is that we have all had diabetic cats of our own. We don't know everything, be we do know an awful lot. Keeping a good relationship with your vet is important. That relationship should be a partnership, not a dictatorship. Two way communication and explanation of WHY is important.

We do have a dosing protocol we use here. Would you like the link to that?
 
If you could add the insulin you are using and the meter you use for testing, your first name and your cat's name, age and sex to the signature, that would be helpful.

I'll go get the dosing protocol link.
 
Prozinc dosing protocol is this one, updated only a few days ago so quite recent.
PROZINC DOSING METHODS

doc 2 -
INSULIN CARE AND SYRINGE INFO Proper Handling and Drawing

doc 3 -
NEW TO THE GROUP: THE PROZINC BASICS. PLEASE START HERE.

doc4 -
GENERAL INFORMATION AND IMPORTANT LINKS—PLEASE READ

We actually do have a separate forum for more experienced Prozinc users, but starting here in the Feline Health (Welcome & Main) forum is the place to be for new members or returning members or infrequent posters.

Get your feet wet here first, learn how to navigate around, get more "eyes" on you at the beginning. More people view this forum than the ISG (Insulin Support Groups) forums.

Anything else we can help you with this evening? Or tomorrow, or another time?

Already feel like I've slammed you with a ton of information. Keep asking questions, it's how we all learned at the beginning too.

p.s. If you click on the Like in the lower right corner after the number of the post, it let's us know you have read the posts back to you.
 
Deb & Wink said:
Yes, that happens a lot. The conflicting advice.

No, Prozinc insulin being an in-and-out insulin does have a bit of flexibility in the dosing. Up to an hour if you need to stall and you can still stay on track for your next shot time. Yes, it's best to space the insulin shots 12 hours apart, but sometimes there are delays. You don't want to be changing up your shot times with every cycle. But there is a little bit of flexibility with Prozinc.

A test at +11 can be very helpful for Prozinc users, as some cats BG's rise quite a bit between the +11 and the pre-shot test. ECID Every Cat is Different.

We have more experience with diabetes than most vets, even though we are only lay people. The common thread among members here is that we have all had diabetic cats of our own. We don't know everything, be we do know an awful lot. Keeping a good relationship with your vet is important. That relationship should be a partnership, not a dictatorship. Two way communication and explanation of WHY is important.

We do have a dosing protocol we use here. Would you like the link to that?
Click to expand...

Yes please!
 
Thanks so much. I had a lot of questions--this is just a new thing to us obviously. He's only been diagnosed a couple months and suddenly has gone from frustratingly high numbers to mostly great numbers but dangerous nadirs. We don't know what larger picture this paints, and wanted mainly advice on skipping a shot or lowering the dose and by how much. I think we'll decided that in an hour. My concern is that skipping the dose entirely throws his progress off track. Seems to me that lowering the dose is the most obvious idea to try first, but should we be trying to see if he manages without insulin for a time? When and how do people make this call.... do you have a link to anything on that? Thanks again... that's it for tonight--will update when I have news if you're interested.
 
toothless said:
When do you recommend skipping doses vs dialing back? Is skipping only for when the dose can't get any smaller?
Click to expand...
Depends on the BG levels. Experience matters when deciding on stalling, skipping or lowering the dose.

Yes, you might try skipping the dose for tonight, getting a couple of BG tests in before you go to sleep.

Then picking things back up in the AM.

Prozinc Dosing Protocol will help to guide you some, but there are nuances that are not written into the protocols.
 
Just an update, we decided to reduce to 1.5u with a bit heavier amount of food after PMPS of 8.0 / 144. We'll see how that goes. To clarify we generally feed two large meals at insulin time and that's it--based on vet recommendation. Both cats have been ok with this. Thanks everyone.
 
toothless said:
3.9mmol (70)
Click to expand...
That’s the bottom end of normal.
Do you need to recalibrate the meter?

Most of us give a couple of smaller meals during the cycles as well as the Preshot meal. Say at +2 and +4 each cycle. It is better for the pancreas and it helps to stop the cat dropping too low. Only two meals a day is old thinking.
Also I would strongly recommend you test before every dose of insulin to make sure it is safe to give otherwise you might find yourself having to deal with a hypo. Also getting in a before bed test each night to check it is not dropping too low. If the BG is lower than the Preshot it is a good idea to set the alarm for later to check the BG has not dropped too low. A lot of cats drop lower at night.
 
Bron and Sheba (GA) said:
That’s the bottom end of normal.
Do you need to recalibrate the meter?

Most of us give a couple of smaller meals during the cycles as well as the Preshot meal. Say at +2 and +4 each cycle. It is better for the pancreas and it helps to stop the cat dropping too low. Only two meals a day is old thinking.
Also I would strongly recommend you test before every dose of insulin to make sure it is safe to give otherwise you might find yourself having to deal with a hypo. Also getting in a before bed test each night to check it is not dropping too low. If the BG is lower than the Preshot it is a good idea to set the alarm for later to check the BG has not dropped too low. A lot of cats drop lower at night.
Click to expand...

After switching to 1.5u without changing food, AMPS and +3 today were both 277. Will try to manage with food on this lower dose for a few cycles. How do we feel about 277? It's higher than where we want to be... I'll see if I can get a nadir today at +6 but I'm at work.
 
Work comes first. So you can afford to buy yourself food, keep the heat and lights on, pay for the car and gas and maintenance, and all the other necessities of life.

I'm sure Toothless considers cat food and a new cat toy now and then necessities.;)

SS still says 2 Units for this morning?
 
Deb & Wink said:
Work comes first. So you can afford to buy yourself food, keep the heat and lights on, pay for the car and gas and maintenance, and all the other necessities of life.

I'm sure Toothless considers cat food and a new cat toy now and then necessities.;)

SS still says 2 Units for this morning?
Click to expand...

That's a mistake. I had copied that number in advance. Fixed.
 
toothless said:
That's a mistake. I had copied that number in advance. Fixed.
Click to expand...
That just tells you we really, really do look at your spreadsheets (SS). And notice those kinds of details and inconsistencies.

We tend to "bug" people about setting up the spreadsheet, then at keeping it updated.
That is because in a crisis situation, we don't want you or us to be scrambling at the last minute to find some data. That is why some information in the signature is important too.

p.s. If you have read a reply, it helps to click on the word "Like" to let someone know you have read the post. I try to do that, but sometimes I forget.

So that way, when you see the "like" at the bottom of the post with my user id listed, you know that someone is paying attention and has read your post. Sometimes, a reply is not always needed. So I simply click on the word "like" next to the post number.
 
Sounds good. We don't always have a computer handy, so we write everything in a book first and update from that. I wanted to throw in the BG #s from memory but forgot to write the new dose. We are very meticulous with the book, but I haven't been updating the spreadsheet as regularly since no one was looking at it but me!
 
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