? REPOST - Dosing Advice - aymptomatic but numbers are a rollercoaster dipping into hypo range

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Hastings (GA) and Paula

Hastings (GA) and Paula

Member Since 2021
Reposting from the ProZinc forum since I haven't gotten any responses since I posted a few hours ago, and it's coming up on insulin time. Apologies if this is not something I'm supposed to do! I tried to delete the thread in the ProZinc forum but couldn't find the option.

I switched to ProZinc from Novolin N on Saturday (2 days ago.) Hastings has been on 2u BID, so we kept him there to see how the ProZinc does before switching up his dose. I have a FreeStyle Libre2 monitor, and a 10 minutes after taking his noon-time (+5) BG reading (he was fed a whole 5.5 oz can of Friskies Pate with his Cosequin supplement at 0700 with his 2 units immediately after, then got 2/3s of a can of Fancy Feast classic pate at +2 and +4.) As you can see from my spreadsheet, it was great at 111 mg/dL. Then 10 minutes later my reader started to alarm - he was at 57, with the trend arrow pointing straight down!

He had been snoozing, but as soon as I called him and his brother for food, he woke up immediately and followed me to their feeding spot. (I was a paramedic for almost a decade before switching careers so I'm comfortable treating hypoglycemia in humans, and the cat protocol seems comparable.) I gave him half a can of some FF gravy lovers with a teaspoon of karo syrup mixed in, he gobbled that down. As you can see, his BG climbed well, but then the same thing happened at 1300 (+6): reading of 107 at the top of the hour, then 10 minutes later the reader alarm went off for a reading of 67 mg/dL. He was snoozing again and woke up immediately for some more Karo and this time 2/3 can of FF pate. (I don't want to overdo it on the carbs in the gravy lovers.) I'm updating his spreadsheet as I go. He's holding in 80s-90s, with the trend arrow flat.

He was up on the windowsill just now, chattering away at the bunnies in the church parking lot next door which is actually out of character for him - since I adopted these two guys at the beginning of the month, Hastings hasn't shown any real inclination to play or chase anything, which I put down to his age, lack of teeth, arthritis, and cataracts. And last night he actually jumped on his brother and trotted around tussling with him a bit. Up until now he's just watched with mild interest when I play with Hercule or batted back a ball if I roll it directly at him.

From the PZ dosing page, it seems I should lower his dose to 1.75u this evening, and delay dosing until he is above correct? I'm working on getting him on an earlier shoot time (aiming for 0600 and 1800 eventually) but I'm guessing I should keep it at 0700-1900 until I find the dose that doesn't drop him so low.

Is there anything I should have done differently? My plan is to keep reading him independent of any alarms every 5 minutes, and give him more food if he falls below 70 mg/dL again. How long should I expect a trough like this to last?

Is his "odd" behavior (of actually acting like a playful cat) something good or bad or will I not know until I have more time to observe patterns?

I'm including a pic of Hastings giving the rabbits a good scolding. Hercule is in the foreground wondering why his afternoon nap is being disturbed.

Update from +11.75 his BG numbers jumped SHARPLY up at +7.25, he's been hanging out in 200-300s since, and promptly went back to sleep, no interest in the rabbits anymore. My spreadsheet is up to date.
 
Do you have an ordinary human meter you can use to double check the BGs with when they seen to drop sharply. Could be an issue with the freestyle libre.
 
Because you recorded the BG of 57 (even though it is possibly an error in the part of the freestyle libre) I would reduce the dose to 1.75 units to be safe until this is sorted out. Better to be safe.
 
Some people have found low numbers on the freestyle libre can be unreliable.
would you mind changing your signature to the insulin you are using now please. Always keep signature up to date as we look at it each time we help you. Thanks.
 
Bron and Sheba (GA) said:
Some people have found low numbers on the freestyle libre can be unreliable.
would you mind changing your signature to the insulin you are using now please. Always keep signature up to date as we look at it each time we help you. Thanks.
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Whoops I was so focused on my SS I forgot the Signature. Thank you for the nudge, all done. :) Hastings ate almost his whole Friskies Pate, and I gave him a 1.75u dose. One good thing out of this - the low glucose alarm on the FreeStyle DOES work! I heard it over my noise-cancelling headphones!
 
Hi Paula, looks like Hastings is bouncing now from those lower numbers, which is very common. He doesn’t seem to bounce for long though which is good.
That is good he is eating so well...always makes it so much easier.
If the numbers drop again in the 50s-80s you can just try feeding some low carb food and testing again in 30 mins.
If it drops under 50 that is when you get out the high Carb and/or the honey or Karo.
When you are not used to the low numbers they are scary and most of us have reached for the high carb the first few times when they dropped lower than 100 so don’t worry. You will get used to how he handles the lower numbers and what he needs to bring him back up. Some cats just need a teaspoon of high carb to respond but others need more.
He has the most gorgeous face! I want to squeeze him tight!
 
Bron and Sheba (GA) said:
Hi Paula, looks like Hastings is bouncing now from those lower numbers, which is very common. He doesn’t seem to bounce for long though which is good.
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Yeah, I've seen humans do the glucose yo-yo, but the low numbers are scary on Hastings because he can't tell me when he's feeling low. But then he was so much more energetic when he was low-ish (~70-90)...I'm hoping when we get this dialed in (and my Zobaline order arrives) he'll demonstrate more playfulness consistently.

If the numbers drop again in the 50s-80s you can just try feeding some low carb food and testing again in 30 mins.
If it drops under 50 that is when you get out the high Carb and/or the honey or Karo.
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Thanks for the tip - tbh the fact that it dropped SO fast was what freaked me out more than the actual number. That precipitous drop is when I've seen the most severe hypo symptoms (in humans) even when people weren't technically in the hypo zone. But he never had any symptoms, beyond apparently feeling pretty good.

He has the most gorgeous face! I want to squeeze him tight!
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He does! My profile pic is the photo the shelter sent me when they told me Hercule (civvie cat) was pair bonded and asked me if I was up to taking on a sugar cat. How could I resist??? If I put my head near him and do a slow blink he will do a bunt without fail, it's been less than a month and he's so lovey.
 
He would be feeling better in 70-90 range as that is a normal BG.
It’s hard they can’t talk but you will get to know him so well. I look at cats quite differently now I’ve had a diabetic cat. I think you become more observant.
Sheba dropped down to 24 once and the only symptom was she was suddenly starving. I’ve never moved so fast as I did then to grab the honey!

Does he have much neuropathy? Sheba was quite affected by it and would slip and slide on wooden floors, couldn’t walk up stairs or jump up on chairs and had to stop every few steps when she was walking. I used Zobaline. Getting them back into more normal numbers is the key. Sheba completely recovered and was able to jump again and walk up stairs etc.
He sounds a beautifully natured boy and he is so lucky to have you,
 
He doesn't have any of the classic symptoms of neuropathy such as plantigrade walking - the vet watched him too during his initial check-up and didn't notice any, but he does have weakness in his hind end, and he kind of braces himself with his legs wide and straight if he walks on anything more squishy than a thin rug - I had to take out a bunch of litter from the box when I watched him first using it, because it was so clear he didn't like the deep sand. I keep it only about 1" deep instead of 3" deep, and I have to clean it 2-3x a day because there's two cats using it and Hastings definitely still drinks and pees more than is normal. So I'm giving him Cosequin now and when Zobaline comes I'll give him that too and see if it helps his movement.
 
Hastings and Paula said:
He doesn't have any of the classic symptoms of neuropathy such as plantigrade walking - the vet watched him too during his initial check-up and didn't notice any, but he does have weakness in his hind end, and he kind of braces himself with his legs wide and straight if he walks on anything more squishy than a thin rug - I had to take out a bunch of litter from the box when I watched him first using it, because it was so clear he didn't like the deep sand. I keep it only about 1" deep instead of 3" deep, and I have to clean it 2-3x a day because there's two cats using it and Hastings definitely still drinks and pees more than is normal. So I'm giving him Cosequin now and when Zobaline comes I'll give him that too and see if it helps his movement.
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I used Cosequin also for Sheba.
Sheba’s neuropathy was also more a general muscle weakness than the classic signs as well. She lost a lot of muscle as well but she got it all back.
 
I hope Hastings gets some of his muscle back - he looks like a dairy cow now! His hips and shoulders are all bony, with a big swinging pot belly. Vet records from the shelter indicate he's lost several pounds from when he was surrendered in January. I'm working on getting him comfortable with being carried (he loves being snuggled and in laps, but as soon as I stand up with him he goes stiff and anxious - I feel like he's very scared of falls/drops) so I can take regular weights.
 
Bron and Sheba (GA) said:
Some people have found low numbers on the freestyle libre can be unreliable.
Click to expand...

Well, it happened again today - somewhat scary - I work from home but I NEEDED to go shopping on my lunch break, to get more FF pate and litter, and also y'know, sustenance for myself. He'd been holding steady, ate well, and with the reduced dose I felt good leaving for an hour. But then on returning I walked in the door and heard the Libre reader alarming. It read 64! Hastings was snoozing and woke up immediately, obviously wondering what the commotion was about. I gave him half a can of FF and some kefir and he ate it fine. I took a reading with the ReliON Prime as soon as I could (after he'd had a few bites of the FF) and it was 94. I tried to get the Libre to read at the same time to compare but it did the classic "can't get a reading, try again in 10 minutes" :rolleyes: Anyways, Hastings is back to snoozing against my work laptop and I'm waiting to see if he dips again so I can get simultaneous readings.

Going to drop down to 1.5u for tonight's dose.
 
Hi Paula, I'm glad you checked with the Relion meter , I see he came back up for you.
Good luck with the reduction tonight. He's such a cutie pie.
Hope you have a peaceful night :bighug::cat:
 
Diane Tyler's Mom said:
Hi Paula, I'm glad you checked with the Relion meter , I see he came back up for you.
Good luck with the reduction tonight. He's such a cutie pie.
Hope you have a peaceful night :bighug::cat:
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Thank you! The libre just said 64 again, I checked immediately with the ReliON and it's at 115...so I'm going to relax, the FreeStyle is definitely wonky at low numbers! (And since it's interstitial BG it lags a bit.)
 
Hastings and Paula said:
Thank you! The libre just said 64 again, I checked immediately with the ReliON and it's at 115...so I'm going to relax, the FreeStyle is definitely wonky at low numbers! (And since it's interstitial BG it lags a bit.)
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Good detective work there!
I would trust the ReliOn as well.
I’m sure he will regain some of his muscle. Some cats lose a lot. Until they are better regulated their body can’t absorb all the nutrients and they are constantly hungry.
He is a lucky boy.
 
Getting a cat regulated, is like getting their old self back.
The change is so slow, I didn't even realize it was happening.
The biggest difference in my Mauer was, that when she wasn't regulated she slept very very deeply. I had to go touch her before she woke up. I didn't realize until she was on insulin, that she was hard to wake up. Now she's back to her old self, and wakes up immediately.

I love you took him in, despite his challenges. Thank you :bighug:
 
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