Trying to understand last night's numbers

[Vinnie Van Gogh's Mom]

I am still sorting out the optimum dose and doing the SLGS method. For the last few days, there has been a decent drop in BG around +4 or +5. But last night, his BG went up instead of down. PMPS was 306, +3 was 334 and +5 was 319. (I also checked his ketones at that point and they were only 0.3 on the Nova Max meter). Then +11 dropped to 200.

I am fairly confident that the insulin dose got in. I separated his fur and watched the needle go into his skin and felt it afterwards and it was not wet. I did go a little shallower with the needle than I normally do, but still fairly confident.

He free feeds and definitely ate between the shot and the +3, but he did not eat between the +3 and +5.

Does anyone have any possible explanations for the odd numbers?

 

[Bandit's Mom]

Does anyone have any possible explanations for the odd numbers?

300, 336 and 319 are more or less the same number since there is a meter variation of 15-20%. Looks like he was bouncing and cleared the bounce by the end of the cycle.

Looks like he is good for an increase to 1U but I'm tagging @JanetNJ for confirmation on dosing.

 

[Vinnie Van Gogh's Mom]

Looks like he is good for an increase to 1U but I'm tagging @JanetNJ for confirmation on dosing.

Thank you! I didn't realize there is that large of a meter variation! Should I do a full curve before increasing the dose? I should be able to do one on Monday.

 

[Vinnie Van Gogh's Mom]

He just dropped to his lowest number ever and is still an hour or 2 away from his normal nadir. He's been super hungry and lethargic. I just gave him a can of roast turkey fancy feast and posted in the main forum but if you see this before I get a response, I'd love some guidance! Freaking out a bit... @JanetNJ

 

[JanetNJ]

He just dropped to his lowest number ever and is still an hour or 2 away from his normal nadir. He's been super hungry and lethargic. I just gave him a can of roast turkey fancy feast and posted in the main forum but if you see this before I get a response, I'd love some guidance! Freaking out a bit... @JanetNJ

199 is the same as 200.... I wouldn't have Skipped... But you could lower to 0.5. Hooray for healing green numbers

 

[JanetNJ]

Don't skip when you get these numbers over 150... It's making the preshots high. If you want to stall for an hour you could... But I like the idea of lowering the dose a little so you'll get two shootable numbers.

 

[Sienne and Gabby (GA)]

I want to support Janet's feedback regarding shooting lower numbers. If your goal is to get Vinnie either regulated or into remission, at some point you need to start shooting lower numbers. If you skip, you lose any regulation you may have. The Prozinc dosing guidelines suggest that a reshot of 150 is a point at which you may want to post and ask for input and as you gather more data, you may want to lower your threshold.

 

[Vinnie Van Gogh's Mom]

Don't skip when you get these numbers over 150... It's making the preshots high. If you want to stall for an hour you could... But I like the idea of lowering the dose a little so you'll get two shootable numbers.

I want to support Janet's feedback regarding shooting lower numbers. If your goal is to get Vinnie either regulated or into remission, at some point you need to start shooting lower numbers. If you skip, you lose any regulation you may have. The Prozinc dosing guidelines suggest that a reshot of 150 is a point at which you may want to post and ask for input and as you gather more data, you may want to lower your threshold.

Thank you. In retrospect, I should have lowered instead of skipping (he ended up getting to 385 last night), but I really didn't know what to do at the time. Between yesterday's hypo scare, reading that they are more sensitive to insulin after they hypo numbers, the lower than normal pre-shot number and the fact that he sleeps in a different room so we can't keep an eye on him at night (along with the trauma of losing a cat to hypoglycemia 20 years ago), I decided it was more prudent to skip than risk another hypo (yes, he only dropped to 68 when I noticed something was off, but it was 1-2 hours before his normal nadir and he was showing mild hypo symptoms - ate 3 cans of food, lethargic and not at all himself). If this happens again, I'll lower instead of skipping. (FYI, he sleeps in his own room because he is a former feral, FIV+ and very aggressive with the other two cats so we have to keep them separate at all times).

 

[Vinnie Van Gogh's Mom]

He also still seemed fairly out of it and not back to normal last night at PMPS - not really wanting to move and a "stoned" look on his face. I did check his ketones as well and they were normal (0.2 on the Nova Max meter). He was more active when I checked on him 5 hours later to get his BG, and I just checked on him again and he's sleeping soundly.

 

[Sienne and Gabby (GA)]

From the outside looking at Vinnie's SS, 68 is not typically hypo territory. We try to differentiate between low numbers vs hypoglycemia. The latter signifies symptomatic hypoglycemia.

The symptoms to be concerned about include but are not limited to:

• staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
• ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
• disorientation (yowling, walking in circles, etc.)
• twitching
• stupor
• convulsions or seizures
• coma

If you observed any of the above, then it's possible that Vinne was symptomatic. He was certainly experiencing lower numbers than what he's typically used to. He may have seemed a bit "out of it" just like most of us who go without food for too long and our BG drops.

You did a great job of feeding the low numbers. One suggestion, though, is to not feed an entire can. When your cat drops into lower numbers, you want to feed in small amounts -- a tablespoon or two. If numbers are dropping low, you may need to feed and re-test in 20 min. intervals. If you feed too much at once, especially if you're using high carb food, there's a risk of shooting the numbers to the moon if you give an entire can. There's also the chance that your cat will vomit which means that he's not getting the carbs he needs to bring numbers up. This post on handling low numbers was written for Lantus but it may provide you with some guidance for what to do when numbers drop.

When you've read about cats being more sensitive to insulin after an episode of hypoglycemia, this is usually if the cat is truly in low numbers (below 40) and typically in those numbers for more than a few minutes -- more like an hour or longer. (Often, there's a trip to the ER involved and the kitty has been on an IV dextrose drip.)

 

[Vinnie Van Gogh's Mom]

From the outside looking at Vinnie's SS, 68 is not typically hypo territory. We try to differentiate between low numbers vs hypoglycemia. The latter signifies symptomatic hypoglycemia.

If you observed any of the above, then it's possible that Vinne was symptomatic. He was certainly experiencing lower numbers than what he's typically used to. He may have seemed a bit "out of it" just like most of us who go without food for too long and our BG drops.

You did a great job of feeding the low numbers. One suggestion, though, is to not feed an entire can. When your cat drops into lower numbers, you want to feed in small amounts -- a tablespoon or two. If numbers are dropping low, you may need to feed and re-test in 20 min. intervals. If you feed too much at once, especially if you're using high carb food, there's a risk of shooting the numbers to the moon if you give an entire can. There's also the chance that your cat will vomit which means that he's not getting the carbs he needs to bring numbers up. This post on handling low numbers was written for Lantus but it may provide you with some guidance for what to do when numbers drop.

When you've read about cats being more sensitive to insulin after an episode of hypoglycemia, this is usually if the cat is truly in low numbers (below 40) and typically in those numbers for more than a few minutes -- more like an hour or longer. (Often, there's a trip to the ER involved and the kitty has been on an IV dextrose drip.)

Thank you for clarifying everything. I was going off of the information in the "How to treat Hypos - THEY CAN KILL!" sticky which listed mild hypo symptoms as "sudden ravenous hunger" and "weak or lethargic" and says

• Hypoglycemia/Hypoglycaemia (low blood sugar) levels are: Below 65 mg/dL (3.6 mmol/L) for adult cats and dogs.

(which he would have almost definitely hit as he was still an hour or two from nadir).

I'll save the post that you shared and keep the feeding in small amounts in mind in case this happens again. Thank you!

 

[Sienne and Gabby (GA)]

Just to be clear, this can be an ECID thing. There are some cats that show symptoms at higher BG numbers. You're there and see your cat. I'm on the other side of a computer screen! When Gabby's numbers were low, she would sit and stare at me. (There was a, "You're an idiot. I need food." look on her face that I learned was her way of telling me what was going on. She could drop very low any not be symptomatic, though. I tested a lot so it's probably why she wasn't symptomatic!

With Lantus and if following TR, reductions aren't given unless numbers fall below 50. This is more likely why I don't become alarmed if numbers are in the 60s. No matter what the case may be, how your cat is behaving is what's important.

 

[Vinnie Van Gogh's Mom]

Just to be clear, this can be an ECID thing. There are some cats that show symptoms at higher BG numbers. You're there and see your cat. I'm on the other side of a computer screen! When Gabby's numbers were low, she would sit and stare at me. (There was a, "You're an idiot. I need food." look on her face that I learned was her way of telling me what was going on. She could drop very low any not be symptomatic, though. I tested a lot so it's probably why she wasn't symptomatic!

With Lantus and if following TR, reductions aren't given unless numbers fall below 50. This is more likely why I don't become alarmed if numbers are in the 60s. No matter what the case may be, how your cat is behaving is what's important.

Thank you again! I definitely struggle with a bit of over-cautiousness based on the past trauma of losing a cat to hypoglycemia, but I am aware of that and doing my best to see things and respond objectively. My husband did confirm that things were off with Vinnie yesterday and was very concerned as well, but I will try not to panic next time he gets into this range. I am doing the SLGS method at the moment as it fits better with my more cautious approach but hopefully I will get more comfortable as time goes on. And hopefully, I didn't completely mess him up by skipping last night!

 

[JanetNJ]

Thank you. In retrospect, I should have lowered instead of skipping (he ended up getting to 385 last night), but I really didn't know what to do at the time. Between yesterday's hypo scare, reading that they are more sensitive to insulin after they hypo numbers, the lower than normal pre-shot number and the fact that he sleeps in a different room so we can't keep an eye on him at night (along with the trauma of losing a cat to hypoglycemia 20 years ago), I decided it was more prudent to skip than risk another hypo (yes, he only dropped to 68 when I noticed something was off, but it was 1-2 hours before his normal nadir and he was showing mild hypo symptoms - ate 3 cans of food, lethargic and not at all himself). If this happens again, I'll lower instead of skipping. (FYI, he sleeps in his own room because he is a former feral, FIV+ and very aggressive with the other two cats so we have to keep them separate at all times).

you are using a human meter, so it's not hypo until under 50. strange he was showing some symptoms.

 

[Vinnie Van Gogh's Mom]

you are using a human meter, so it's not hypo until under 50. strange he was showing some symptoms.

Ahhh...I now see that the under 65 being hypo was for the AlphaTrak. But the sticky I was using also says Mild Hypo numbers are between 40 & 60 and that the actual number is less important than "where it is headed. In other words, if you get a BG of 100 mg/dL or 5.6 mmol/L or less and there are still several hours or more before the insulin peaks, your need to watch your cat (and the numbers) carefully and take appropriate steps." Based on his symptoms and the fact that he was still an hour or two away from his nadir, I probably still would have given him the roast turkey ff (still low carb but higher than his normal food) and tested frequently, but maybe I wouldn't have done the FF with gravy or panicked as much. This was a good learning exercise I guess. I hope I didn't mess things up too much by skipping last night.

 

[JanetNJ]

Ahhh...I now see that the under 65 being hypo was for the AlphaTrak. But the sticky I was using also says Mild Hypo numbers are between 40 & 60 and that the actual number is less important than "where it is headed. In other words, if you get a BG of 100 mg/dL or 5.6 mmol/L or less and there are still several hours or more before the insulin peaks, your need to watch your cat (and the numbers) carefully and take appropriate steps." Based on his symptoms and the fact that he was still an hour or two away from his nadir, I probably still would have given him the roast turkey ff (still low carb but higher than his normal food) and tested frequently, but maybe I wouldn't have done the FF with gravy or panicked as much. This was a good learning exercise I guess. I hope I didn't mess things up too much by skipping last night.

you were right to steer the number up, but regular low carb food probably would have done it.