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[Brie’s Mom]

Hi there,

I am very new to this and have a few questions - Brie has been bouncing a lot. She was just diagnosed in December 2022 so I have heard that its expected newly diagnosed, but I have no idea how to interpret her levels and there haven’t been many patterns.

Background:
On NYE I accidentally gave her her normal 1u when her BG was only PMPS 7.8mmol (140) (Very dumb I know). I realized my mistake right away and got her to eat some more food, hoping that nothing would happen if she ate more. Her BG started dropping fast over the next few hours and I ended up feeding her high carb treats, kibble, and wet. When that wasn't working I started putting corn syrup on her paws and she would lick it all off, as she would not let me rub on her gums. It still kept dropping and when it got to 3.2 (66) after everything we were trying I called our emergency vet and they said to continue monitoring and call back if she drops below 2 (40). She started to perk up a few hours later but I woke up every hour that night to make sure she was still high enough. I went into shock and almost a panic attack during the ordeal (especially because it was my fault). I did a reduced dose (0.5u) the next morning because I read on here that they are more sensitive to insulin the day after and because it was New Years Day, my vet wasn't open to ask.

Anyways! So today she dropped down to 4.7mmol (84) @ +4 today and I freaked out and started feeding her more. She ended up at 3.7 (66) @ +6.5. I was still pretty traumatized by the past incident so I am worried that I went overboard today and was too quick to feed her more as she then jumped to 11mmol (198) @ +7. That seems like a super large jump for 30 minutes and she has been over 22mmol (414) (I use the freestyle libre and it only goes up to 22mmol (414), otherwise just shows HI.) ever since.

So my question is this - When should you react to a low BG? If I hadn't tried to fix it this afternoon would the BG have started to come back up on its own?

I'm heading back to work tomorrow and won't be home until AMPS+5.5 which is usually around her nadir. I'm worried I may miss a potential low glucose event. Am I just being crazy? Any help or opinions would be amazing! Thank you so much!

 

[FrostD]

I'm sorry nobody was around to help. I'm on "maternity leave" so to speak, so not watching the forums as actively. For future reference, if you need advice and aren't getting it here quickly enough, feel free to post on Main Forum where there are more eyes.

So, each drop below 90 is a reduction of 0.25U. I see the 56 today. I would suggest a reduction down to 0.25U (provided no history of ketones) since that's further below 90 than we'd like and since the lower numbers are giving you a bit of anxiety.

Was she on steroids recently? Or some sort of infection or health issue? Apologies if this has been asked before.

These very high numbers are what we call bounces. Her body isn't used to the lower numbers, so her liver panics and releases stored glycogen and counterregulatory hormones in order to spike BG back up. Those effects can last up to 6 cycles. When she clears a bounce, she tends to have a longer slide down. So what happened in NYE was just that - very late nadir, and your next shot was very soon after nadir, hence the big drop. I'd have done exactly what you did in that situation because we can't always predict what will happen in that situation. With that low of a preshot, I'd have suggested trying 0.25U if you could monitor and had hypo kit. Otherwise, a skip.

As far as intervening with food using a human meter:
50s: if it's near nadir, you can usually just give a bit of low carb (less than 10%) to help keep afloat. If it's before the usual nadir or youre not sure, a little (1-2tsp) medium carb (10-14%) is best bet.
40-49: high carb (15% or higher) wet food. Test every 20 mins as that's how long it takes the food to take effect. If you suspect she's really tanking, you can certainly test sooner to see if she drops below 40 ->
Below 40 is high carb wet and some sort of syrup/fast sugar. Test every 10 mins as that's how quickly the syrup will work.

Caveats would be things like too much insulin given , double dose given, or very large/fast drops. In those cases you're better off posting on Main Forum, possibly with a 911 prefix. It usually needs more carbs sooner to stay ahead of potential problems.

The syrup serves as a quick boost to BG to get out of danger zone. But you still need the high carb wet to sustain that boost, they drop fairly quickly again just on syrup alone. While the kibble can help, there's two challenges with that - (1) it takes longer to affect BG and (2) it takes longer to wear off and makes subsequent cycles a little harder to predict. But of course if that's all you have, you give it!

When managing low/hypo numbers, one thing to keep in mind is.you don't want them getting too full. So it's usually best to give the gravy from the high carb food and just a tiny bit of the food itself (1-2 tsp). If they get too full/don't want to eat and numbers still keep hanging low, it becomes more difficult to manage.

 

[Suzanne & Darcy]

Hi there,

I am very new to this and have a few questions - Brie has been bouncing a lot. She was just diagnosed in December 2022 so I have heard that its expected newly diagnosed, but I have no idea how to interpret her levels and there haven’t been many patterns.

Background:
On NYE I accidentally gave her her normal 1u when her BG was only PMPS 7.8mmol (140) (Very dumb I know). I realized my mistake right away and got her to eat some more food, hoping that nothing would happen if she ate more. Her BG started dropping fast over the next few hours and I ended up feeding her high carb treats, kibble, and wet. When that wasn't working I started putting corn syrup on her paws and she would lick it all off, as she would not let me rub on her gums. It still kept dropping and when it got to 3.2 (66) after everything we were trying I called our emergency vet and they said to continue monitoring and call back if she drops below 2 (40). She started to perk up a few hours later but I woke up every hour that night to make sure she was still high enough. I went into shock and almost a panic attack during the ordeal (especially because it was my fault). I did a reduced dose (0.5u) the next morning because I read on here that they are more sensitive to insulin the day after and because it was New Years Day, my vet wasn't open to ask.

Anyways! So today she dropped down to 4.7mmol (84) @ +4 today and I freaked out and started feeding her more. She ended up at 3.7 (66) @ +6.5. I was still pretty traumatized by the past incident so I am worried that I went overboard today and was too quick to feed her more as she then jumped to 11mmol (198) @ +7. That seems like a super large jump for 30 minutes and she has been over 22mmol (414) (I use the freestyle libre and it only goes up to 22mmol (414), otherwise just shows HI.) ever since.

So my question is this - When should you react to a low BG? If I hadn't tried to fix it this afternoon would the BG have started to come back up on its own?

I'm heading back to work tomorrow and won't be home until AMPS+5.5 which is usually around her nadir. I'm worried I may miss a potential low glucose event. Am I just being crazy? Any help or opinions would be amazing! Thank you so much!

I hope Brie was doing okay. I don’t see anything on her spreadsheet since January 10 and I just wanted to check on her.

 

[Brie’s Mom]

I hope Brie was doing okay. I don’t see anything on her spreadsheet since January 10 and I just wanted to check on her.

Thank you for checking in! She is doing fine - just a lot happening right now and haven’t been updating the chart. She is on a freestyle libre monitor right now so her data and patterns are just on my phone app. Will update once life settles down a bit! Than you so much for checking in though!!

 

[Suzanne & Darcy]

Thank you for checking in! She is doing fine - just a lot happening right now and haven’t been updating the chart. She is on a freestyle libre monitor right now so her data and patterns are just on my phone app. Will update once life settles down a bit! Than you so much for checking in though!!

Okay. Well I hope that she's doing well and you can share soon. That would make me so happy. Thanks for the update.

 

[Brie’s Mom]

I'm sorry nobody was around to help. I'm on "maternity leave" so to speak, so not watching the forums as actively. For future reference, if you need advice and aren't getting it here quickly enough, feel free to post on Main Forum where there are more eyes.

So, each drop below 90 is a reduction of 0.25U. I see the 56 today. I would suggest a reduction down to 0.25U (provided no history of ketones) since that's further below 90 than we'd like and since the lower numbers are giving you a bit of anxiety.

Was she on steroids recently? Or some sort of infection or health issue? Apologies if this has been asked before.

These very high numbers are what we call bounces. Her body isn't used to the lower numbers, so her liver panics and releases stored glycogen and counterregulatory hormones in order to spike BG back up. Those effects can last up to 6 cycles. When she clears a bounce, she tends to have a longer slide down. So what happened in NYE was just that - very late nadir, and your next shot was very soon after nadir, hence the big drop. I'd have done exactly what you did in that situation because we can't always predict what will happen in that situation. With that low of a preshot, I'd have suggested trying 0.25U if you could monitor and had hypo kit. Otherwise, a skip.

As far as intervening with food using a human meter:
50s: if it's near nadir, you can usually just give a bit of low carb (less than 10%) to help keep afloat. If it's before the usual nadir or youre not sure, a little (1-2tsp) medium carb (10-14%) is best bet.
40-49: high carb (15% or higher) wet food. Test every 20 mins as that's how long it takes the food to take effect. If you suspect she's really tanking, you can certainly test sooner to see if she drops below 40 ->
Below 40 is high carb wet and some sort of syrup/fast sugar. Test every 10 mins as that's how quickly the syrup will work.

Caveats would be things like too much insulin given , double dose given, or very large/fast drops. In those cases you're better off posting on Main Forum, possibly with a 911 prefix. It usually needs more carbs sooner to stay ahead of potential problems.

The syrup serves as a quick boost to BG to get out of danger zone. But you still need the high carb wet to sustain that boost, they drop fairly quickly again just on syrup alone. While the kibble can help, there's two challenges with that - (1) it takes longer to affect BG and (2) it takes longer to wear off and makes subsequent cycles a little harder to predict. But of course if that's all you have, you give it!

When managing low/hypo numbers, one thing to keep in mind is.you don't want them getting too full. So it's usually best to give the gravy from the high carb food and just a tiny bit of the food itself (1-2 tsp). If they get too full/don't want to eat and numbers still keep hanging low, it becomes more difficult to manage.

SO sorry for the late reply!!! Thank you so much for all of that info!! No infections or other health issues - and no ketones as well. The vet had switched her to 0.5 units for the past few weeks but her numbers stayed high so we will be increasing again. Sorry no updated spreadsheet but I’ll update when I can!