Stalling - New & clueless - really low test? Now what?

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starling

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Gave insulin around 7am when he was at 126. Obviously that was a mistake. Now (3pm) he's at 45. What should I do?
 
Do you have some gravy wet food? If so, give him a few tablespoons of the gravy. If no gravy food, see if he will eat a few tablespoons of regular food and mix just a little dab of honey or karo syrup in it. Is he acting alright? Get another test in 20 minutes. My guess is that he might have been even lower earlier and may now be on his way up, but it is possible that he is continuing to go down.
 
We have a saying around here to "feed the forties." Feed some of the regular food and then get another test in about a half hour to make sure he's not continuing to drop. If you're worried, you can feed some higher carb gravy (just the liquid) mixed in with food or a couple of drops of Karo.
 
He seems okay. None of the symptoms of low BG. I just gave him some milk with honey (need to get some high-carb food), and he took maybe a lick, plus the honey I was able to get him to lick from his lip, tested again and he was at 55.
 
So he is on his way up - good. You need to feed him a little more and test again in 20 minutes. You want 3 rising tests before you relax.

Would definitely not shoot under 180 and would reduce the dose. You probably won't geta shootable number tonight unless he really bounces up. Even if he bounces high, I'd reduce the dose.
 
Okay, definitely, I'll reduce and/or eliminate the dose. Right now I'm going to run to the store for HC food. Shouldn't take more than 20 minutes, and then I'll test, give him some HC and test again. Thanks so much, Alex
 
I would just give the regulAr food now. Save the high carb if he is dropping below 40. Mark it with a permanent marker so you don't feed it by mistake and can find it in a hurry if you need it. It could be that he is just generally headed up or the honey may have temporarily raised the number. So a test when you get home is a good idea.

I wouldn't stop the insulin. He had a normal reaction - the dose was just too high for the number. So now the trick is to find a good dose and be sure you do the waiting game if you get a number under 180. I think I'd try .5 units if he is high enough tonight and plan to get a before bed test to be sure he is looking good.
 
Sue, I went out and got four cans of Fancy Feast Gravy Lovers, but I took your advice and fed him the low carb. Ten minutes later, he was at 64. So I should keep testing until 7, when I usually stick him, and if he's above 180 give him .5 unit?
 
That sounds good. I am going to guess he will not be high enough to shoot at pmps. So then you need to decide if you want to stall awhile, without feeding, to see if he rises enough. The problem is that can mess up your schedule in the am. Or you can skip - especially if he is in the low 100s or below - because an hour or so may not bring him up.

So then tomorrow am, we would think he would be pretty high since he would have been 24 hours since the last shot. Even if he is, I would reduce the dose to .5 and see what that does. And if, by chance, he is under 200, no shot - either stall or skip again.

Good job handling the low numbers today! The first time is always scary and you did great. It does look like he is doing very well with the diet change and insulin. More monitoring and possible good numbers in his future (anti jinx)
 
Kpassa and Sue, thank you so much for the help, and the encouragement. I'd hug you if I could. At a few minutes before 6, he was at 87, so I think I'll lean toward feeding him, but skipping the insulin tonight, depending on his numbers.

I still don't have a basic understanding of normal cat blood sugar. What's a healthy, normal range for a cat without diabetes, and what am I looking for when I test? When would I give one unit? When would I give a half unit?

How often would you say cats are able to get off insulin all together with a low carb diet? I mean, is it possible that we could eventually taper the insulin down to nothing?

The vet said remission happens, but rarely. Like she said maybe 10-15% of her patients might go into remission. She's very nice, but she was pushing Prescription MD dry food, and when I asked (before I found all of you) she said the jury still wasn't in on the effects of low carb diets on diabetic cats. I know sort of a lot about the adverse effects of carbs on people, so I'm already a believer.

Last question. I'm comfortable with routines, and we're getting accustomed to the morning and evening routines of test, feed and stick (although after this afternoon, I understand the whys of testing a lot better), but what about the rest of the day/night, routine-wise? Do you just test maybe twice in between, or whenever you think of it?

Thanks so much for being there, Alex
 
starling said:
I still don't have a basic understanding of normal cat blood sugar. What's a healthy, normal range for a cat without diabetes, and what am I looking for when I test? When would I give one unit? When would I give a half unit?

How often would you say cats are able to get off insulin all together with a low carb diet? I mean, is it possible that we could eventually taper the insulin down to nothing?

The vet said remission happens, but rarely. Like she said maybe 10-15% of her patients might go into remission. She's very nice, but she was pushing Prescription MD dry food, and when I asked (before I found all of you) she said the jury still wasn't in on the effects of low carb diets on diabetic cats. I know sort of a lot about the adverse effects of carbs on people, so I'm already a believer.

Last question. I'm comfortable with routines, and we're getting accustomed to the morning and evening routines of test, feed and stick (although after this afternoon, I understand the whys of testing a lot better), but what about the rest of the day/night, routine-wise? Do you just test maybe twice in between
Click to expand...

A cat, off insulin, ranges from 40-120 with the majority of the time in double digits. A regulated cat is in the lower 200s at preshot and double digits midcycle, but not below 40, which as you know :mrgreen: is too low. With ProZinc, it's all about the data. You use the numbers associated with previous doses to figure out what to do next. So yesterday, at 180, one unit gave you a preshot this morning too low to shoot (with the likelihood that he was quite low overnight). So based on that data, we suggest lowering the dose by half. So then you give that dose awhile (as long as the numbers are in a high enough range) and decide whether it's a good dose or needs to be tweeked.

If you vet prescribes dry food, it's pretty amazing any of her patients go into remission. Our rate here is pretty high - not sure if anyone has done the math, but I'd say a majority of cats go OTJ.

With ProZinc, the preshot numbers plus the nadir guides your dose. The nadir is usually in the 5-7 hour after the shot range. So if those numbers are low enough but not too low, you have a good dose. If the preshot is too low to shoot or the nadir goes too low, the dose needs to be reduced. Aother good time to test is about 3 hours after the shot. That number gives you an idea how the cycle is headed: is he dropping too fast or does it look like a nice slow drop?

Here is the protocol for ProZinc

http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=109077

You might post on the PZI forum. Everyone there is familiar with your insulin and can help with dosing. It's also helpful to see their spreadsheets.

http://www.felinediabetes.com/FDMB/viewforum.php?f=24
 
Comparing a human glucometer to a pet-specific glucometer is like reading temperature in Celsius vs Fahrenheit. Both are correct. You just need to know the reference ranges to interpret what the numbers mean.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]


* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Hi again Alex and extra sweet Mini!

Good job on the signature and I do think you've got it on the spreadsheet too!

I see you didn't shoot tonight. He's doing well for so soon! In the U column, you'd put NS (No Shot) ....that lets us know that you didn't shoot instead of just forgot to put a number in there...lol

Great job today on catching that low too! You really did awesome! The first time China went below 50, I had read to give her some karo, syrup or honey...so I dumped about a half cup in a bowl and she lapped it up!! Needless to say, she came up!!

Glad to see you have some people who use ProZinc watching out for you now too!

Looks like the switch to the low carb food is really helping (and your vet knows nothing...which is a pretty common theme around here!) We have lots of cats that go OTJ (Off the juice) and are diet controlled only, and when we see a cat that's doing as well as Mini is this quickly, it's a great sign!

Keep asking questions. The people here are great with offering their time and advice and can help you learn all you need to know!
 
Mini was 192 at 6 am and 254 after a meal at 7am, so I gave him .50 and I guess we'll see what happens.

Thank you all so much for the great information. I want to sit down and read everything until it makes sense, and I'll probably have more questions. But I really appreciate your help and support. Alex (and Mini!)
 
So it's six pm, and we're at 131. I'll feed him nowish, and shoot .50 in an hour? Or should I not shoot him with those numbers? He seems to feel really good right now. A.
 
So this number is 12 hours after the shot? If so, no, I wouldn't shoot. It's too low. You could do the stalling thing and see if, without food, he goes up to around 200 and then shoot. But I am going to guess he won't get there.

So, because you didn't get a shootable pmps, I'd either skip or do the stalling thing (if you haven't fed) The next preshot that is nearer 200, I'd lower the dose again. You will need to eyeball .25 We can help you do that.

All great news. Reduced dose, still low numbers - probably went quite low at mid cycle. Time to reduce again.
 
Have you seen this Conversion chart?

It's hard to eyeball .25 unit doses, especially with the U40 syringes that you usually use with ProZinc since most are whole units only. You can get U100 syringes from any pharmacy with half unit markings that might make it easier, but you would have to use the conversion chart.

What's going to be important though is to keep the dose consistent, so if you do try to eyeball .25 unit, (and you still have to eyeball on the U100's, they just have the extra lines at .5 unit) you might want to prepare a syringe with a colored liquid like coffee, tea, colored water and decide where you are going to say .25 is. Then when you draw your insulin, compare the syringe to the one with the colored fluid in it so it's the same dose each time.
 
Sue, oh, this is great news. I'm just going to hold off on shooting him tonight then.

Chris, interesting way to get consistency with the .5, but that makes sense, and it's such a little amount.

He's still not out of the woods. His back legs bother him, I'd say a lot. I guess it's the neuropathy. The vet said the muscles in his back legs were really thin, before she diagnosed the diabetes, and she thought he had arthritis. When he looks stiff, it's not so much like he's walking on his hocks. It's more like he walks with his back hunched. And I know the Zobaline takes a while to work.

But for whatever reason, he's still not jumping onto his old haunts, like my desk and beside the window, the way he used to, oh three months ago? But what's great is his drinking and eating are normal, and the over-peeing has stopped. He just seems fatigued. But now I know that he's been sick for a long time, and his chemistry's been all over the road, so it probably takes a while to get back? Or is this maybe sort of what you'd expect from a 12-year-old cat with diabetes.

Oh, and does neuropathy hurt like arthritis? Or are his legs numb?

Thanks, Alex
 
It can be both...numb and painful

Have you considered trying acupuncture? We've had several members here who've had excellent results and the cats actually seem to enjoy it

And I'm pretty sure Sue wanted you to go to .25 on your next dose (if the pre-shot was high enough), not .5, which makes it even harder to eyeball if you're using syringes that only have whole unit markings.

The U100's you can get that have .5 unit markings (no syringes have marks at .25) so we all have to either eyeball it or use calipers to try to get that tiny little dose.
 
Oh, okay, .25 tomorrow. I do have a nice pair of calipers. Acupuncture's a great idea. I think someone around here offers it.
 
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