Low Reading for PMPS - feed and retest?

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Melly

Melly

Member Since 2015
Hi folks,

Sisko has had a pretty grumpy couple of days. Usually he's sweet as pie but not so much recently (ETA his grumpiness has been centered around feeding time and attempts at drawing blood for BG tests). I blame it on 1) being poked an proded and 2) being really hungry and restricted on food.

We haven't been able to get a BG reading since Thursday until tonight at his PMPS and he was measuring 2.7. We fed him and he gobbled up his food, but haven't given him any insulin yet.

Thoughts? Would you retest now or wait a couple hours?
 
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As a side note, his grumpiness this afternoon extended to defecating behind the tv. He's been hungry and hot and lazed around, but hasn't looked unwell. We tried liver treats at his +6 BG test (which was unsuccessful) and he ended up tossing his cookies at that time. Just the liver treats though, no other food came up.
 
That's a 48 for those of us in the US and that's too low to shoot (you just multiply your number by 18)

Since you just fed him, I'd retest in about 30 minutes....anytime they drop below 50 that's a reduction in dose...Looks like 2.5 is too much
 
Hi @Chris & China - he's piggying down some food right now and we're going to retest in a bit. We tried to retest now and couldn't get any blood - this guy is NOT a bleeder... We've skipped his shot for now and are going to see what the next test shows. I think that's the most frustrating thing - the inability to get enough blood to have the meter run a test.

@Critter Mom - we will definitely be calling the vet on Tuesday morning. We missed them by about 10 minutes this afternoon and they're closed now through Tuesday for the holiday weekend. If things get worse, we have an emergency vet that we can take him to but for now he's still eating and alert. Both cats are lazy and hot today with the heatwave we have going through right now so his behaviour lines up with hers...except for the crapping behind the tv bit. And the "screw off don't poke my ears" routine. But I think I'd be feeling that way if I were him too.
 
We've tested him this morning and are going to bring his dose back to 2.0 - updates on his spreadsheet. We'll be testing again at +6 to see how he's doing.

Does anyone have the key for the colour-coding on the spreadsheet?
 
You use the conditional formatting and assign colors based on the cell entry.
Here are instructions. Set the ranges to match your spreadsheet. Once one cell is done and working correctly, use the paint roller icon in Google Drive Sheets to apply that formatting to other cells.
 
If you check out BJ's signature, see her 'Glucometer Notes' document. It covers the reference ranges.

Key numbers for an Alphatrak are:

HYPO THRESHOLD: 3.8/68 (FDMB uses this - my vet gave me 3.9/70 as the hypo threshold).

TR Target Range: 4.4 - 7.2 mmol/L (published protocol sets a higher safety margin of 4.4 at lower numbers)

Nominal Renal Threshold: 12.8/230 - 13.9/250, depending on which veterinary reference source consulted (varies for each cat - may be a lower value, e.g. 11/200).

If you have a look at Saoirse's spreadsheet, I've customised the reference ranges at the top of the sheet for Alphatrak use.


Mogs
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Hi @BJM I've updated the spreadsheet - I didn't realize that the first page actually linked off of the world values and translated it.

@Critter Mom Thank you! Checking that out now - that's what I was looking for. :) I have a chart printed off of Wikipedia that has some BG values but it doesn't correspond exactly to the values in the SS.
 
Would you please add country to your signature? Ideas and advice often depend on what is available in the local areas.
 
For reference, the healthy range for a non-diabetic cat (the euglycaemic range) is typically quoted as:

3.9/70 - 8.3/150

I've split the ranges in Saoirse's sheet because I wanted to specifically colour code her sheet to identify very clearly when her numbers were in the TR healing range (max 7.2/130). I set the warning threshold at 4.4 in line with the published guidelines in the TR protocol.
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BJM said:
Would you please add country to your signature? Ideas and advice often depend on what is available in the local areas.
Click to expand...
It's a pity that our location doesn't appear under our avatars anymore (like it did on the old forum software).

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Okay, guys - I'm hoping to draw upon the collective expertise of the FDMB. If I should instead be posting this in the Lantus forum please let me know.

Last night we had a really low BG reading of 2.7 at the PMPS. We decided to hold off on giving insulin, and this morning when testing at his AMPS he was 21.7. We lowered his dose to 2 units from 2.5. Today at +6 he was 11.8 and at +11 he was 11.4.

We've just given him his evening food but I'm really leery about giving his pm insulin to him, in case he goes hypo in the middle of the night. My understanding is that it's better for his BG to be a little high than low, correct? We don't have much data right now but everything I have is in the spreadsheet. It's just not looking like a curve and that's confusing the heck out of me.
 
Thanks, Aine. That first date looks a little screwy - it should be 7/30/2015, I must have written over it. I've fixed it up but I know it takes a few minutes to post.
 
Well done with the home testing and catching that low, Melly, and also on reducing the dose: that 49 is w-a-y below the Alphatrak hypo threshold value (68).

As you note, you don't have much data yet. The usual 'no shoot' when there's not much data is 200 on a human meter. On an Alphatrak, it would be a little higher.

Does Sisko have any history of ketones, or any other underlying health issues? Also, did you do any more BG tests after the 49 last night?

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We didn't do any additional blood tests last night, just gave him food and waited things out. We're not currently testing for ketones (our vet indicated that if we were going to do BG testing at home that we really didn't need to do the ketosis sticks) and other than this, he's a super-healthy, awesome guy! I love this dude to the moon and feel pretty helpless at this point, but my gut (and my husband's) was saying to skip the shot and your no-shoot guideline seems to fall in line with what we were thinking.

You don't know how incredible it has been to have this board. We're pretty alone in this process and I think if this place wasn't around, I'd be even more of an emotional roller-coaster than I already am.

(((hugs))) to you @Critter Mom and everyone here!
 
The 391 yesterday morning was what we call a "bounce"....Bounces happen when 1. the blood glucose drops too low 2. the blood glucose number drops very quickly (like 50+ points an hour) and 3. Sisko's body has gotten used to living at higher numbers, so when he goes lower than he's "used to", he bounces. (or a mix of reasons)

Bounces are when the liver releases stored sugars and hormones to bring the BG up quickly. It's a normal (but frustrating) part of the sugardance.

Bounces take up to 6 cycles (3 days) to clear, so you just have to hold the dose and let the bounce clear.

If you keep getting Pre-shot numbers that are too low to shoot, that's a real good sign that you're on too high a dose. It may be best for you to start over at the correct dose based on Sisko's weight and see how he does now that you're testing and learning how Lantus works

The starting dose for cats on Tight Regulation is weight (in kilos) x .25U and then usually we'll start a bit lower just for safety
 
Melly said:
We didn't do any additional blood tests last night, just gave him food and waited things out.
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I was worried about that. It is possible to have symptom-free hypos on insulin. From what I've read here I think it may not be uncommon for a Lantus hypo to be asymptomatic. That means that you can't solely rely on clinical signs to know Sisko is safe. You need to feed a little (karo or gravy from a higher carb food - depends on how low) then test in 15 mins to make sure number is back over 68. If not, feed a little more and test in 15 mins, then rinse repeat until you get 2 rising numbers not influenced by food. There is a sticky on how to handle low numbers somewhere on the forum but I can't find it any more. :(

Re the ketones, I'd suggest testing for them at least once a week using a urine test strip (e.g. Ketodiastix) - nothing wrong with a belt 'n' braces approach. It's still early days in Sisko's sugar dance and it's no harm to do a quick check to make sure ketones aren't part of the mix.

I see Chris has posted above. I think a start-over would be a good plan. It's more straightforward to edge curves upwards from a lower start point - it can reduce the possibility of triggering bounces, and it's safer.

Hugs for you too, Melly.
:bighug::bighug:


Mogs
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Thanks @Chris & China - we got a pretty decent number this morning (in comparison to mornings past) and have dialed all the way back to 1 unit of Lantus. The vet started us out on 2 units last Monday evening, then increased us to 2.5 on Thursday evening. 1 would be the dose according to his current weight and admittedly, I'm a little gun-shy at this point to keep him on 2. Thank you for the info about the bounce. Oh the many things we still need to learn!

@Critter Mom An asymptomatic hypo? That is frightening. I've located that hypo/low thread and will be printing it out at work tomorrow. We assumed, hopefully not wrongly, that the food would bring his BG up. :( That low also impacted how we view BG testing and I don't know that we'll ever dose him with insulin again without testing him first. Our vet was pleasantly surprised that we were commited to home-monitoring but it scares the pants off me to think about the number of times we shot in the last week (our first week!!!) without testing either because we couldn't get a sample or because we were under the impression that we didn't have to.

I've redone my SS with the AlphaTrak numbers that @BJM provided (thank you!). It really paints a different picture.
 
Hi Melly,

I had no choice but to dose blind when Saoirse first started on Caninsulin (no support from diagnosing vet for home testing). It was a nightmare I never wish to repeat. :nailbiting: I'm glad your vet is supportive of your decision to test. Makes such a difference. Our current vet is a great advocate of it (has a diabetic kitty himself). He still raises an eyebrow at my monitoring choices now and again, but we agree to differ. His interest is in seeing Saoirse as well as possible and he trusts that I know what I'm doing with my more frequent testing, and that it's pointless to try to tell me to do otherwise. :p ;)

The trouble with just giving honey is that the carbs burn up fairly quickly. It's a good idea to get hold of a wet food with gravy to add to your hypo kit. The gravy carbs can last a little longer than the karo or honey, and they don't fill up the kitty's tum (in case more carbs are needed to keep the BG rising after a low).

Melly said:
I've redone my SS with the AlphaTrak numbers that @BJM provided (thank you!). It really paints a different picture.
Click to expand...

Doesn't it just. When I started Saoirse's spreadsheet I was using the standard international template with the colour coding for human meters.

It. Wrecked. My. Head.

It made me much more worried about Saoirse's safety because dangerous numbers would be colour-coded as 'safe' due to human meters reading lower than pet meters. Also it was a bit dispiriting to see reds where there should have been yellows; blues where there should have been greens. The early stages of regulation can be disheartening. Changing the colour codes on Saoirse's spreadsheet helped me to be more hopeful - and sugar kitty parents need that. :)



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