? SubQ Fluids Bring Down BG Significantly?

[Jia&Sabrina]

Hi all,

For those of you who give your kitties subq fluids, have you noticed a significant drop in kitties' blood glucose after fluids?

Sabrina had hypo twice in November. On both days we gave her 40ml fluids. Today we gave her 30ml at +5 and her PM preshot is only 109.

I asked her IM vet if there is a correlation between subq fluids and bg. She said no but it does seem like there is a correlation, at least for Sabrina.

Just curious if anyone else has similar experience and wonder why. Is that because fluids somehow dilute her blood glucose or the fluids activate depot?

TYIA!

 

[FrostD]

It's possible. It also looks like she's bouncing though and it could be coincidental, or related. Meaning, she's bouncing then breaking the bounce on the same day you happen to give fluids. Or, the fluids do allow her to go even lower, and contribute to the bounce.

I know your spreadsheet says custom dosing, but you're really not giving the depot time to settle. Also really shouldn't call it TR, as you don't test enough for that. I also think you are probably missing a fair amount of lower numbers. I understand all of this may be caused by your schedule, just mentioning it to keep her safe.

How do you determine if she needs fluids?

 

[Jia&Sabrina]

It's possible. It also looks like she's bouncing though and it could be coincidental, or related. Meaning, she's bouncing then breaking the bounce on the same day you happen to give fluids. Or, the fluids do allow her to go even lower, and contribute to the bounce.

I don't think it's bounce. I checked her log after her hypo events and realized that whenever we gave her fluids, her AM preshot numbers were lower. We used to give her fluids in the evening but moved it to the morning so we can keep a closer eye on her.

I know your spreadsheet says custom dosing, but you're really not giving the depot time to settle. Also really shouldn't call it TR, as you don't test enough for that. I also think you are probably missing a fair amount of lower numbers. I understand all of this may be caused by your schedule, just mentioning it to keep her safe.

Thank you for your concern Just edit the spreadsheet. I didn't call it TR. We tried TR in March and switched back to SLGS. After her diagnosis of pancreatitis in May we decided not to check so often as she's been through quite a lot (her pancreas has been markedly enlarged and we had to syringe feed her for almost four months until September).

How do you determine if she needs fluids?

She is obsessed with water. Sometimes she stays in front of her fountain without drinking. Whenever we notice behavior like that we give her fluids to make her feel better. Her IM thinks it's due to high BG but we suspect it is related to pancreatitis because she could still crave for water even when with BG being in mid-200.

 

[Jia&Sabrina]

I understand all of this may be caused by your schedule, just mentioning it to keep her safe.

I should start to test more.

 

[Lisa and Witn (GA)]

When Witn was on fluids I noticed a similar thing happen. I usually would give her fluids around +7 and that seemed to help reduce the BG drop some. You still will need to test after fluids to check the BG levels.

 

[Jia&Sabrina]

When Witn was on fluids I noticed a similar thing happen. I usually would give her fluids around +7 and that seemed to help reduce the BG drop some. You still will need to test after fluids to check the BG levels.

On 11/16, her PM preshot was 385. We gave fluids at +3 and she dropped to 48 at +8. That was a scary night. I will def try to test more often, especially after fluids. Thank you!

 

[JL and Chip]

For those of you who give your kitties subq fluids, have you noticed a significant drop in kitties' blood glucose after fluids?

Sabrina had hypo twice in November. On both days we gave her 40ml fluids. Today we gave her 30ml at +5 and her PM preshot is only 109.

I asked her IM vet if there is a correlation between subq fluids and bg. She said no but it does seem like there is a correlation, at least for Sabrina.

Just curious if anyone else has similar experience and wonder why. Is that because fluids somehow dilute her blood glucose or the fluids activate depot?

What type of fluids are you giving?
How are you measuring 30-40ml?

SubQ fluids can lower BG a bit in some cases, but I’d be seriously surprised if 30-40ml would make much difference. Definitely not enough to go from a high number to hypo.

Assuming you’re measuring the subQ’s correctly, I’m more inclined to suspect your insulin dose is too high. Might I ask what your logic was for remaining at 2.75u after the hypo? Lantus is dosed based on the LOW BG values (not pre-shot values or other numbers in the cycle), so the 48 on an AlphaTrak signaled an immediate need to lower the dose (even if the reading was affected by fluids).

I’m glad you’re going to do more testing. It’s very common for cats to need higher insulin doses while battling a bout of pancreatitis and then have their dosing needs drop as the pancreatitis resolves. I encourage you to go over to the Lantus forum and re-read the starred “Sticky” posts at the top of the board, especially the dosing protocols. With SLGS (which I believe you said you’re following?) you’d reduce insulin dose any time the BG drops below 90 in a cycle.

Finally, I don’t believe excessive drinking or lying by a fountain indicates a need for subQ fluids in and of itself. Just curious — is that how the vet told you to gauge the need? I might learn something new here.

 

[FrostD]

Aside from what JL said - I'm more inclined to think the water behavior is possibly nausea, or pain. If she has pancreatitis, they are often nauseous and in pain. Are you giving her any medication for that? How is her appetite?

I was always told that anything less than 50-75 mL of fluid was pointless, but maybe that varies from vet to vet. I also only give fluids with more classic signs of dehydration - the scruff doesn't "snap back" when lifted, gums are getting tacky.

 

[Jia&Sabrina]

What type of fluids are you giving?
How are you measuring 30-40ml?

It's lactated ringer's solution and we use 60mL syringes to draw the fluid out from the bag.

Might I ask what your logic was for remaining at 2.75u after the hypo?

I lowered the dose by .25u after the 1st hypo and lowered again after the second. She was at 2.5u (down from 3u) for 9 cycles and then I increased to 2.75u as I thought the hypo events were caused by the fluids. Without administrating fluids, she remains high most of time (except for when she has diarrhea...)

It’s very common for cats to need higher insulin doses while battling a bout of pancreatitis and then have their dosing needs drop as the pancreatitis resolves.

Sabrina was diagnosed with severe pancreatitis in May and her pancreas is still in a bad shape. It is markedly enlarged under ultrasound, even after she's got her appetite back, her pancreas remains unchanged (last check was in September). The internist doesn't think the pancreas would get any better and she doesn't want us to do steroids due to diabetes. I asked about BG being brought down by fluids again today and she left me a message saying it is just coincidence.

I encourage you to go over to the Lantus forum and re-read the starred “Sticky” posts at the top of the board, especially the dosing protocols. With SLGS (which I believe you said you’re following?) you’d reduce insulin dose any time the BG drops below 90 in a cycle.

I have the dosing protocol imprinted on my mind but I haven't done a good job following it... due to lack of sufficient testing......

Finally, I don’t believe excessive drinking or lying by a fountain indicates a need for subQ fluids in and of itself. Just curious — is that how the vet told you to gauge the need? I might learn something new here.

When Sabrina was diagnosed with pancreatitis, I told internist her obsession with water and was told that Sabrina was dehydrated and fluids would make her feel better... hmm...

 

[Jia&Sabrina]

Aside from what JL said - I'm more inclined to think the water behavior is possibly nausea, or pain. If she has pancreatitis, they are often nauseous and in pain. Are you giving her any medication for that? How is her appetite?

She stopped eating completely in May but eventually got her appetite back in September. She was on Cerenia, ondansetron for nausea and bupe for pain. We don't give her any meds right now as she consistently eats on her own.

I was always told that anything less than 50-75 mL of fluid was pointless, but maybe that varies from vet to vet. I also only give fluids with more classic signs of dehydration - the scruff doesn't "snap back" when lifted, gums are getting tacky.

She is a small cat. Used to be 9.5lb but only 8lb right now. So we don't give her more than 80mL.

 

[JL and Chip]

SubQ fluids are certainly a part of pancreatitis treatment, but ongoing pain meds and anti-nausea /anti-emetic meds can be important too. It’s not unusual for diabetics to have pancreatitis, unfortunately. I’ve had to deal with it in my crew and it can be a delicate dance.

Have you seen the Pancreatitis Primer? If not, it’s worth a read. https://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

We’re here and happy to help if we can.

 

[Jia&Sabrina]

SubQ fluids are certainly a part of pancreatitis treatment, but ongoing pain meds and anti-nausea /anti-emetic meds can be important too. It’s not unusual for diabetics to have pancreatitis, unfortunately. I’ve had to deal with it in my crew and it can be a delicate dance.

Have you seen the Pancreatitis Primer? If not, it’s worth a read. https://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

We’re here and happy to help if we can.

Thank you! Really appreciate it!

 

[Katherine&Ruby]

I made a note in Ruby's spreadsheet each time she got subQ fluids to see if it had an effect on her BGs. Sometimes it did, sometimes it did not, so I could not correlate the two actions. I do think subQ fluids can be helpful and can't harm unless your kitty has heart issues.