Very low BGs without signs of hypo?

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PrettyBlueEyes

PrettyBlueEyes

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How low is "too low"? One part of me says below 50 or 60, those seem to be two common numbers in everything I've been reading. But if the number is below 50, but my cat is asymptomatic in regards to hypoglycemia, am I right to be worried? Or am I being a typical "freaked out" newbie diabetic mom? He is normally around 60-which seems low to me as well- at peak time but has gone as low as 40.

Leo drops below 60 (a few occasions in the last week or so), but shows absolutely no signs of hypo. Last night, I checked him before my bedtime as is a regular thing for us. I got a reading of 40, tested again, and got another 40. The third test read 46, so I am pretty sure the value was accurate. I was so scared for him and had the Karo at the ready. He, however, didn't seem to turn a hair. In truth, the little man was spunky and playing happily while I was worrying, scatting across the kitchen with his tail arched and eyes wide, batting his plastic spring across the laminate and thoroughly enjoying himself. I ended up giving him a smudge of his favorite hairball medicine from his pre-DX days (the first ingredient is malt extract) and stayed up until i had two readings that were on the rise. This morning, no harm, no foul, AMPS was slightly elevated, but didn't get over 250.

He's currently getting 1.25 units of ProZinc BID. Maybe I should drop it to just 1 unit? I called his vet to ask this question but have not yet heard back.

Thank you for your thoughts/advice.

Kate & Leo
 
how low is too low depends on where in the cycle you are. and just to warn you, this can get confusing :-) because what low number you get and where it occurs in the cycle will determine if you intervene and how.

if you get a 50 only 2 hours after giving a shot, definitely too low for that early in the cycle and you'd want to intervene, most likely with some higher carb food or possibly even karo.

if you get a 50 8 hours after the shot, not so bad and unless you've determined your cat to be a late nadir-er, no need to intervene really with anything. you would though have to think about your next shot.

personally, if i see a 40 at nadir, with no symptoms of anything else going on, i don't intervene at all. some of my non-diabetics occasionally test in the 40's.

i just had a 36 at +4 the other day in my diabetic and heck yeah i intervened. but whereas some people would do so with karo or higher carb food, my Mousie has been diabetic long enough she's pretty predictable to me and i knew if i gave her some of her regular low carb food it would bring her up just fine. sure enough, after a tbsp of her regular food she was up in the 50's within 1/2 an hour and hung out there for the next couple hours so that's all i had to do.

all of the above goes out the window though if you see symptoms of hypo. personally, my opinion is that if there are symptoms, go for the high carb food or karo immediately. i don't care where in the cycle it is. i'd rather deal with higher numbers later than an ER visit or dead cat now
 
His 40 last night was an hour before nadir-for Leo on ProZinc, it is usually +5 to +5.5. He's usually between 50 and 60 at nadir...which made me worry. If he was already that low, I was concerned about where he would be when the insulin peaked in an hour or so.

The only time I actually had to use the Karo was similar to what you were describing-vet told me to start him out at 2.5 units BID, which was the recommended dose for his weight. We dutifully gave our first dose of 2.5 units only to discover the hard way that it was too much-he was at 42 at +3! He was symptomatic at that time (still walking, but seemed confused, like he didn't know quite where he was), and I stayed up the entire night watching him and reading-the night I found this site and learned about starting low and going slow!

Thanks for reassuring us! We really appreciate it.

Kate & Leo
 
One of the important things is whether the number is going down. If you get a 50 at +4 and give a little low carb food and he continues to go down, you want to be watching. If you get a 40 and give the food and he goes down, it's time to try some higher carb food. With PZI, we wouldn't want a cat dropping below 40 without intervening with Karo.

Yes, I would lower the dose to one unit. Your nadirs suggest the dose is a little high.
 
Thanks for bringing that up, Sue-I've never had a situation where he was too low, gave food, and he kept going lower, so it's good for me to be aware that this could happen. I had given him some canned chicken (rinsed in water) which he likes much more than his Purina DM. He was pleased-like he was thinking to himself, Hey! I got a great big bonus treat! and fifteen or so minutes after that when I tested, I didn't see much of a change at 48 so I gave him the smudge of hairball medicine and continued with chicken and low carb food. Within an hour or so he had come up to a point where I felt it was ok for me to sleep.

Will scootch my sweet boy's dose down a bit in the AM.
 
agree with Sue about dropping the dose a smidge. that 40 an hour before nadir could have become a problem because anything under 40 can become a symptomatic hypo quickly. good thing you caught it. did you feed him or anything when you saw that 40? i would have, and probably would have went with our regular low carb food because as i mentioned, Mousie responds to it well, and then i still would have tested her thru nadir just to be safe. some cats though won't respond quick enough to low carb food so you could have even went with a slightly higher carb food than normal, what some call a medium carb food, to bump her up just a little.

edited: was typing at the same time and see in your last response that you did respond to that 40. good job! :-)
 
fwiw, the chicken is virtually carb-less and yeah, it's not unusual for the kitties to lose interest in the DM. might check into some of the low carb Fancy Feast foods, Wellness, or even Friskies. and for that matter, a can or two of higher carb is always good to have on hand too just in case you need to get kitty's numbers up.
 
Sigh...will be dropping the dose tomorrow for sure. Same situation tonight-my baby just threw me a 38 and a 40 on two consecutive tests. He's currently chowing down some low-carb wet food mixed with a little chicken to make him more eager to eat it.

The 1.25 unit dose has given readings in the 50s and 60s at nadir consistently for a little while now...then last night and tonight, these very low readings. He seems to be eating about the same amount during the day. What could be going on?

Worried...I think it's going to be another missed bedtime for me!

Edited: Leo has about an hour, give or take, to go until nadir again tonight.
 
I would test again in 15 minutes. If he continues to go down, try some higher carb food. You don't want him lower than 35.

Every cat is different. Some take a few cycles to adapt to the insulin; some takes a week or more. Sounds like it is starting to work better. That's why testing is so vital.

For testing advice, you can also post on the PZI forum. Everyone there used or uses your insulin.

But for things like tonight, when you need eyes, post here. The PZI forum is much smaller than Health; you may need to post and then check back for responses.
 
It means a lot to me to have eyes. A lot.

I just tested him a few minutes ago-he's come up a bit to 48. I feel okay turning him over to my boyfriend, who's been solidly supportive and proactive through Leo's course. He knows the signs/symptoms as well as I do, and how to treat a hypo-we even have the reference page printed out on our fridge. Leo continues to show no real hypo symptoms-he's currently grooming himself and preening. Around a half hour until nadir...I think I'll just stay up.

Thank you for your help tonight-all of you. I can't tell you how much it means to me. I'm still pretty new and nervous- Leo and I have been together for thirteen years and I can't imagine life without him...
 
Sounds like a better number.To be safe, you always want to get two rising numbers before you relax.

It sounds like you are being expert at low numbers. But it'll be nice when you can have a little higher numbers at nadir. (a regulated- on insulin- cat is in the +200s at preshot and 100 or under at nadir, but above 40.). I hope a lower dose will get you there.
 
just got home and almost done with my kitty care for the night but wanted to check in and see if there were any more questions.

fwiw, i'm sure you've seen it here somewhere in all your reading but just in case not, cat's can go into remission. which can also explain the lower numbers. you are giving insulin and if kitty's pancreas is starting to heal much, it can be kicking in some too, thus lower numbers. so then the dance becomes kitty gives some insulin, you don't give as much, kitty gives a little more, you give a little less, and so on until eventually kitty does all the work themselves. remission.

anyhow, gotta give sub q's for the night and then i can relax too :-) nite
 
Scooter has never shown hypo symptoms, even when dropping as low as 29. He just gets really hungry, and that is only sometimes too :lol: Keeps me on my toes.
 
Thanks, everyone. After I had two rising tests last night I felt ok trying to sleep-BF continued testing until he went to bed at around +8.

Leo was lower than normal until that point, but not in the danger zone. Still rising, but he only made it up to 95 by the time BF went to sleep. AMPS this morning was only 175-so I held the dose as long as I could, and finally gave .75 units when he was up to 212. BF doesn't leave for work until noon today so he will be testing until he leaves. I figured if he is reading high when I get home from getting the reduced dose so be it-as was mentioned earlier, I'd rather deal with that than the alternative.

I had read about cats having honeymoon periods and going into remission and honestly, that's what I'm hoping for. I just didn't think it would happen quickly like this (if this is what is happening-oh, I hope!!). I'll be doing another full curve this weekend to get a better idea of what's going on at any given time.

Thanks again,

Kate & Leo
 
It does look like he would like to get off insulin. You will need to monitor carefully and give small doses. This is great news but can be a little hairy for you! .75 may still be a little high. Let's see what the day brings....

(You are using U100 needles and the conversion chart, correct?)
 
One thing that is important to note is that cats are usually do not show hypo symptoms until the hypo situation has reached a severe point. Cats can go for some time experiencing hypos without visible symptoms, because their livers will dump glucose into their bloodstream to compensate for low blood sugar. Dangerous symptomatic hypos usually don't occur unless the cat has been hypo-ing repeatedly and their body can't compensate for the low blood sugar anymore, or far too high a dose of insulin is given for their bodies to compensate.

If he drops below 50, you want to boost it back up above 50. Repeatedly dropping into a hypo range can cause his blood sugar to spike and fall, and we want to keep it as level in the normal range (60-120) as possible.
 
Sue-I'm using U40 syringes that were supplied by the vet when I got his insulin. Is it better to use the U100 and convert? Would using the U40s be causing me to dose improperly?

BF has texted twice saying Leo is looking/feeling/testing ok so far. Most recent report was 121 with over an hour until peak time. Keeping my fingers crossed...when I did his most recent full curve last Saturday I seem to remember a significant drop in that hour or two before peak. I don't have his graphs in front of me at work though.

I remember that from when he had the hypo I described last night, from the starting dose of 2.5 units that the vet recommended. He was ok until all of a sudden he just looked so confused, like he didn't know where he was. He would respond to me saying his name, but it was like he was reacting in slow motion. That's one of the reasons I've been so darned nervous when I see those 40s...I'm scared that he'll be going along just fine then...it will hit.
 
It is easier to use the U100 needles when you are giving doses other than the one unit and .5 units. But it's a matter of choice. If you have them and can eyeball .75 and then lower than .5, they are fine. Most PZI users doing mini doses - under .5 - use them before it is so much easier to dose consistently at small doses.

If you decide to use them, you must use the conversion chart. (ProZinc is a U40 insulin so to use U100 needles, it requires converting.) Here is the chart: Conversion chart: http://www.felinediabetes.com/insulin-conversions-printer.htm
 
Sue and Oliver (GA) said:
Julia, she is on ProZinc, not Lantus. Kate, the 2 insulins are dosed very differently.
Click to expand...

Whoops, my bad. I don't know why I thought I read Lantus in there somewhere. Sorry! :oops: I've deleted my comments above.
 
62 at our historical peak time, +5 to +5.5. So not too bad, better than what we have been getting the last couple of evenings. BF will test once more before he leaves for work, and we will see what Leo's PMPS has to say when I get back.

Thanks for the info regarding the syringes-I panicked a bit thinking I had messed up his dosing when I first read what you wrote about using the U100s and the conversion chart. I feel ok eyeballing at .75 and will probably also feel okay doing .5 if we need to go down to that tonight.

I so appreciate your help, ladies. Hopefully as I get more used to what is happening with my sweet boy I will start to relax-I know Leo is picking up on my fears and I don't want him to be stressed.

I'll post again when we have a PMPS. Just so glad I have a pet-loving boss who lets me post while at work.

Thank you for helping us!

Kate & Leo
 
Well, PMPS read 173, so I'm holding for now and letting the little guy eat. I am thinking about whether or not to drop him to .5-to me it seems like maybe I should? Both pre-shot values today were in the 170s and nadir after his AM dose of .75 units was 62.
These are the lowest pre-shot values we've gotten since we started insulin.
 
You are right to wait but next time don't feed. Can you get a test in the next few minutes before the food will have time to raise the bg levels?
 
I was able to get a reading before he had eaten more than a few bites. The values I got have me a tad puzzled.

I checked the first two times with a Relion Confirm that was checked against the vet's glucometer and confirmed to be fairly accurate-first test, 136. Second, 127. Got out my backup meter which is a One Touch that I got from a family member. 140.

I gave his .75 unit AM dose twelve hours ago.
 
It probably means he is having a long cycle, still going down, not up(fantastic that you didn't shoot!). That means the dose is too high.

So you have choices. You can wait until he is high enough to shoot. This is complicated by the food so it could take a couple hours - you want a number not influenced by food. That will probably mess up your schedule?

The other option is to skip. That probably means he will be higher than usual in 12 hours, 24 hours since the last shot. But you don't want to react to that higher number. It won't be " real".

Two suggestions. Take a test in 30 minutes or so. If he continues to go down with the food on board, it means his pancreas is joining the party! Second, I would definitely lower the dose more. Maybe .5 or even less.

This makes your life complicated, but it is great progress!
 
I don't really mind my schedule getting messed up, I can deal with little sleep since there's a 3-day weekend coming up. Also, BF's hours are much more flexible than mine and he's volunteered to give tomorrow morning's insulin if need be. I'll get the test in a little bit, then wait for him to be high enough to shoot, my no-shoot number is 200.

I'll gladly take my life being complicated if it means my little guy is doing better!
 
We have no data so it's hard to tell. Nice number. Too low to shoot. The food didn't seem to make his numbers go up very much, so his pancreas could be working a little bit.
 
I agree, not a bad number at all, and too low to shoot. What you can try is to get another test in an hour or so. If his numbers stay about the same, or even drop a bit, that can indicate a pancreas that is trying to regulate on its own, just like nature intended! It would be a very positive sign.

Carl
 
I checked the first two times with a Relion Confirm that was checked against the vet's glucometer and confirmed to be fairly accurate-first test, 136. Second, 127. Got out my backup meter which is a One Touch that I got from a family member. 140.
Click to expand...

All of those readings fall within the accuracy/tolerance range of the meters (+/- 20%), so even though they don't match perfectly, essentially it means the numbers are identical. Even the 153 you just got falls into that range, so his number is not going up (which is a good thing).

For SS purposes, just pick one, like the 136, for his PMBG number.

Carl
 
Creating the forum-specific spreadsheet is definitely a project on tap for this weekend. I'd been keeping his numbers on Excel, then making line graphs out of them. It helps me to have the "visual" representation. Although, I'll be up for a while waiting with him so... :idea:
 
Great job on the SS! Very colorful one, but lots of nice green numbers on it. :smile:
His BG seems to be holding pretty well. It may rise to a shootable number, but you'll want to wait until the morning at this point. If you do see a number that lets you give insulin tomorrow morning, dropping down to .5u seems like a good idea too. You should be able to eyeball that on the U40 syringe?

Carl
 
Well, he's +15 since his .75 u this morning. Is that what is meant by cycle?

Hi Carl, nice to see you, I've read a lot of posts by both you and Sue. I feel okay about eyeballing a .5 dose, but if he goes lower than that I would like to get the U100 syringes, after reading on those today it seems they may be easier when measuring small doses.

I will wait till tomorrow morning. Very curious to see where he will be at that time.

Thanks all,

Kate & Leo
 
Just remember, he may jump up before your morning number because it will be 24 hours since the last shot. But regardless, he needs a reduced dose, no more than .5 If he surprises us and is in the low 200s, you might even want to consider .25.

The U100 needles will really help. You might join us over on PZI. Carl and I post there also. We have several people doing mini doses and they can help you.
 
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