Low glucose levels, need advice

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Ray_williams

Ray_williams

Member Since 2023
Good morning everyone, Cody was doing fine for the last few days, thanks for everyone’s input on the forum.

But we had a somewhat difficult issue from last night. After last night’s injection, he’s number has stayed below 100’s, we have to have a bit syrups (1/5 of tsp) to prevent sugar going lower than 50, and it worked.
Cody through up around 530 this morning, but he looks still ok.
However this morning when we tested him, his number is low again like in the 50s.

Under this situation, I made choices delay the insulin shot. However, if resume, should I still try to give hime twice today? Also, at what dosage? If I drop the dosage to quick like to 2 to 3 units, will that be ok? Thank you for reading my lengthy post.
 
How you proceed depends on how long you need to stall and if your work week schedule will accommodate a late shot. Whenever you shoot, your next shot is due 12-hours later. Actually, you can move the shot time either by 15 minutes twice a day or 30 minutes once a day if you shoot late this morning. However, given how low Cody's numbers are and that you're following SLGS, it's prudent to skip the shot.

You will also need to reduce the dose by 0.25u at PMPS.

It looks like you changed Cody's food. What are you currently feeding him?

Also, can you put more information in your signature? The signature information should include:

Make sure your signature is up-to-date.
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback. There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
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Sienne and Gabby (GA) said:
How you proceed depends on how long you need to stall and if your work week schedule will accommodate a late shot. Whenever you shoot, your next shot is due 12-hours later. Actually, you can move the shot time either by 15 minutes twice a day or 30 minutes once a day if you shoot late this morning. However, given how low Cody's numbers are and that you're following SLGS, it's prudent to skip the shot.

You will also need to reduce the dose by 0.25u at PMPS.

It looks like you changed Cody's food. What are you currently feeding him?

Also, can you put more information in your signature? The signature information should include:

Make sure your signature is up-to-date.
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback. There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Click to expand...

Thank you for the information, please let me know if my signature setup correctly.

We switch Cody's diet to BFF wet, Combined with Rx Dm dry, however, he has not been interest to the dry food for few days now.
 
Red & Rover (GA) said:
Your spreadsheet.
The AMPS and PMPS columns contain the time (I think) of the shot. These columns should list the test taken before the shot.
Which column are you currently putting the test number before the shot?
Nothing wrong with putting the time on your spreadsheet but it should have its own column. If you need technical help to do this, just ask.
Click to expand...
Those numbers are indeed times. I will see if I could adjust it
 
I also don’t understand what dosing method you’re following. You’re increasing by full units which we don’t recommend. We do dose adjustments by 1/4 units. Her earned a few reductions that you didn’t take. When you got that 79 you actually increased the dose instead of reducing it. Have you read all the yellow sticky notes on the Lantus forum, especially the one about the dosing methods we use here?

@Sienne and Gabby (GA) i think he should be at least at 4.75 going back to the first reduction missed and given all the missed reductions, wdyt?
 
@Red & Rover (GA) - The AMPS and PMPS columns are for the BG reading at shot time. It doesn't include the time of the shot. The only situation when it's helpful to include information about the shot time is if the caregiver is stalling. Take a look at Gabby's SS for 11/30/15 to see what I mean.

@Ale & Bobo & Minnie (GA) - take a look at the original post. He was increasing based on his vet's advice.

Ray - I think what you're seeing is the result of Cody not wanting the DM dry food. Unfortunately, DM dry is a high carbohydrate food. (And if you look on the bag, it's not "diabetic" food, it's now labeled "dietetic" food. The manufacturer lost a class action suit because there's nothing that needs a prescription in the food.) If Cody is eating a low carb food -- I'm assuming the BFF is low carb (all of the canned BFF are low carb; the pouches are not), you're seeing the result. By removing a high carb food, his blood glucose numbers are going to be much, much lower. All I can say is that I'm VERY relieved that you were home testing.

I agree and disagree with Ale. I do think Cody needs a dose reduction but not for the same reason she suggested. Generally, we don't suggest playing "catch-up" with dose reductions. However, when we do suggest a larger than typical reduction is if there's a change from a high carb to a low carb diet. The dry DM food was keeping Cody's numbers propped up given that he was on a large dose of insulin. In all likelihood, your vet was taking the advice from the pet food manufacturers and believing that the "prescription" food was good for the condition for which it was labeled. This isn't the case. I'd be curious if your vet knows the carb count in the DM dry. FWIW, I had this argument with my vet a lot of years ago. She was both embarrassed and surprised that the very pricey "prescription" food was higher in carbs than Fancy Feast.

If you're planning on removing the DM, you decidedly need to reduce Cody's dose. If he's not eating the DM, I'd stash it somewhere in case you need something high carb. If that's an acceptable plan, I'd drop the dose back to 5.0u but keep an eye on his numbers. You've been doing a great job of testing. Until we know how Cody is responding to Lantus without the high carb food, you may need to continue to monitor carefully. Cody's dose was raised far more rapidly than we recommend. When this is the case, it's easy to skip over what may be an effective dose. We suggest changing doses in 0.25u increments.

This is the link to the dosing methods we use with Lantus -- either Tight Regulation (TR) or Start Low Go Slow (SLGS). If you are interested in following either one of those methods, let us know.
 
Ale & Bobo & Minnie (GA) said:
I also don’t understand what dosing method you’re following. You’re increasing by full units which we don’t recommend. We do dose adjustments by 1/4 units. Her earned a few reductions that you didn’t take. When you got that 79 you actually increased the dose instead of reducing it. Have you read all the yellow sticky notes on the Lantus forum, especially the one about the dosing methods we use here?

@Sienne and Gabby (GA) i think he should be at least at 4.75 going back to the first reduction missed and given all the missed reductions, wdyt?
Click to expand...

Thank you for the info, definitely will adjust the does tonight
 
Sienne and Gabby (GA) said:
@Red & Rover (GA) - The AMPS and PMPS columns are for the BG reading at shot time. It doesn't include the time of the shot. The only situation when it's helpful to include information about the shot time is if the caregiver is stalling. Take a look at Gabby's SS for 11/30/15 to see what I mean.

@Ale & Bobo & Minnie (GA) - take a look at the original post. He was increasing based on his vet's advice.

Ray - I think what you're seeing is the result of Cody not wanting the DM dry food. Unfortunately, DM dry is a high carbohydrate food. (And if you look on the bag, it's not "diabetic" food, it's now labeled "dietetic" food. The manufacturer lost a class action suit because there's nothing that needs a prescription in the food.) If Cody is eating a low carb food -- I'm assuming the BFF is low carb (all of the canned BFF are low carb; the pouches are not), you're seeing the result. By removing a high carb food, his blood glucose numbers are going to be much, much lower. All I can say is that I'm VERY relieved that you were home testing.

I agree and disagree with Ale. I do think Cody needs a dose reduction but not for the same reason she suggested. Generally, we don't suggest playing "catch-up" with dose reductions. However, when we do suggest a larger than typical reduction is if there's a change from a high carb to a low carb diet. The dry DM food was keeping Cody's numbers propped up given that he was on a large dose of insulin. In all likelihood, your vet was taking the advice from the pet food manufacturers and believing that the "prescription" food was good for the condition for which it was labeled. This isn't the case. I'd be curious if your vet knows the carb count in the DM dry. FWIW, I had this argument with my vet a lot of years ago. She was both embarrassed and surprised that the very pricey "prescription" food was higher in carbs than Fancy Feast.

If you're planning on removing the DM, you decidedly need to reduce Cody's dose. If he's not eating the DM, I'd stash it somewhere in case you need something high carb. If that's an acceptable plan, I'd drop the dose back to 5.0u but keep an eye on his numbers. You've been doing a great job of testing. Until we know how Cody is responding to Lantus without the high carb food, you may need to continue to monitor carefully. Cody's dose was raised far more rapidly than we recommend. When this is the case, it's easy to skip over what may be an effective dose. We suggest changing doses in 0.25u increments.

This is the link to the dosing methods we use with Lantus -- either Tight Regulation (TR) or Start Low Go Slow (SLGS). If you are interested in following either one of those methods, let us know.
Click to expand...


Thank you for the detailed information, I think Cody just decided not gonna touch the dry food anymore lol. However, do you recommend me to continue the sub q fluid as well while given 5 units? we skipped morning dose, and seeing him number gradually coming back up now, last test I had, it's 158.
 
Cody is clearly a smart cat!

I don't remember why the vet has put him on sub-q fluids. If they are medically necessary, they should be continued. I would just closely monitor Cody's BG levels. I just don't want to suggest you lower the dose so much that you lose the forward momentum you're seeing.

My apologies for misunderstanding Kel's (Red & Rover) post. Cody's spreadsheet looks much better now that you have the actual blood glucose numbers as your pre-shot test data.
 
I agree with Sienne's suggestion of dropping the dose back to 5 units.

Could you put either "skip" or "NS" (no shot) in today's units entry for the AM, just so we know you skipped the shot instead of just forgetting to enter the data. Looks like Cody's really needs that reduced dose!

By the way, the Freestyle Libre is a human meter, not a pet meter - which is the spreadsheet template you've selected. It does make a difference in what we call very low numbers. The human meter template has numbers below 50 going lime green, while it's 68 for pet meters. Regardless of spreadsheet format, Cody still needs that reduced dose.
 
@Ray_williams
Nope still can't see it
This is what I see when I tap on the SS
https://docs.google.com/spreadsheet...1954IRQTLJdArImeiwJLnfgJ8/edit#gid=1182885903

To set spreadsheet sharing permission:
* At the top right of the spreadsheet screen click on Share.

* In the pop-up dialog box click on the Get Link section.

* Change link access from 'Restricted' to 'Anyone with the link' and make sure that the permission on the right hand side is set to 'Viewer'.

* Click Done to save the changes.
 
Last edited:
Yeap, we can see it now. Thanks!

You seem to be changing the dose up and down randomly. Are you following SLGS? If so, you need to hold a dose for 7 days unless he drops under 90. You lowered it to 3 units. You need to hold that dose to give it time to work. If you keep changing up and down, you won’t know what the right dose is
 
@Ray_williams
I definitely agree with @Ale & Bobo & Minnie (GA)
You are changing the dose up and down
SLGS METHOD
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
 
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