What is the range for hypoglycemia?

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Picknickchick

Picknickchick

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I think I might have made a mistake, thinking that my cat was going into the hypo range when he was not. I had read in http://www.felinediabetes.com/dummies.htm:

"Normalization" is the term used when the control is perfect and the BG stays in the normal range around the clock (normal BG for the average cat is 70 - 120 mg/dL -- yours might be higher or lower). Normalization is rarely attempted, because it means the cat is on the edge of hypoglycemia several hours a day, so what we do is "regulation" -- holding the BG most of the time at levels which minimize harm to the cat. Your aim will be to keep the blood glucose above 100 all the time, and below 200 as much as possible.

Which means that this is the ideal range, between
5.6 mmol/L = 101
11.1mmol/L = 200

Having read that, yesterday, my cat had readings of 5.4 and 4.8 which is 97 and 86, so I freaked out, thinking that he was going hypo. I'm using Lantus, and a Bayer Contour EZ meter. But with human meters, the low is actually around 2.8, is that right?

I was very concerned about what I thought was a "low" reading, when it was actually a good reading, and reacted by lowering my cat's insulin dosage. Now, today he is high. So I should go back to the dosage where I was getting the 5s and 4s, is that correct?

I wrote my vet an email about this, but she hasn't responded, so I hope someone here can advise me.
He is high right now, so is there anything I can do? Give him a small amt of insulin? Or do I have to wait until his regular PM shot time, which is in 4 hours? Leaving him high makes me nervous.
 
You don't want to give any more insulin until the normal shot time.

Normal range BG numbers using a human meter are 40-120, so anything below 40 is considered "hypoglycemic", although many cats show no symptoms of "hypo" at that level.

With Lantus, the nadir number (lowest point in the 12 hour cycle) is the indicator for adjusting the dose. If you see a number below 50, it indicates the dose should be lowered, usually in increments of .25 units. That assumes you follow the "tight regulation" protocol.

The high number you see now is most likely a "bounce" due to the low BG you saw last cycle, and not due to you shooting a lower dose this morning. If a cat experiences lower numbers than it is used to, it can trigger the liver to release stored glucose in an attempt to ward of low BGs. The "low" isn't necessarily dangerously low, just lower than what the body has become used to.
 
This is so helpful, thank you! I'll put him back at 3 u BID.
Thanks for explaining the high - this is something I don't think my vet knows. She doesn't seem to be sharing too much information with me, so I'm glad I found this place.

Fortunately, I am on vacation and can test him night and day for a few days.
Thanks again for your help.

Just called the clinic and they said that anything above 3 mmol/L (54) is okay, and I should be aiming for anything between 3 and 15.
But honestly, they don't seem too hep to the testing, which I think is key. They always ask me to go by his behaviour, which for me is not a good indication, necessarily.
The people on here have the knowledge and experience that they don't.
 
Picknickchick said:
They always ask me to go by his behaviour, which for me is not a good indication, necessarily.
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Behavior can definitely be misleading. Mikey reacts almost the same when he's been running too high or running too low. There are times I've test him, thinking he's going low, and I get a result of 320. There are other times I think he's just fine and I test him and he gives me a 38. nailbite_smile There are plenty of stories on here where cats have been acting just fine and normal...right up until they have a seizure from too low blood sugar. For me, I'd rather trust my glucometer than my own personal judgement. :lol:
 
KPassa, thank you, this sounds so sane.

Anyway, the vet called and recommends this course of action:
- no insulin tonight at 8
- tomorrow don't check BG because it'll be all over the place
- no insulin at 8 am or pm tomorrow
- insulin starting Friday AM 2u and then 2u BID
- do curve next Friday unless weirdness

I read her Carl's comment regarding the bounce, and she agreed with it. She thinks he is having a Somogyi and had a seizure because of hypo. She said that in case he is going into remission, this allows him to do so, and gives him a fresh start with the insulin. She said that the protocol for a Somogyi is to withold the insulin for 3 injections.
 
Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in

parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on

insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and

ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
Picknickchick said:
I read her Carl's comment regarding the bounce, and she agreed with it. She thinks he is having a Somogyi and had a seizure because of hypo. She said that in case he is going into remission, this allows him to do so, and gives him a fresh start with the insulin. She said that the protocol for a Somogyi is to withold the insulin for 3 injections.
Click to expand...

I've never heard of this "Somogyi Protocol" before.... Honestly, if he's high, give him insulin because he needs it, don't hold it back from him just because he went low yesterday. And especially since you'll be around these next few days to monitor. As for a "fresh start," all that you're doing is depleting the Lantus depot and you literally have to start over for 5 days to rebuild it. I agree about giving a reduced dose, HOWEVER, since you've been giving him 3u, drop it down to 2.75, or even 2.5u. Dropping it all the way to 2u could be problematic and cause him to run high. Of course, any time you see a number under 50, that's another dose reduction (by .25u to .5u).

Since you've also changed the diet and he's also recovering from pancreatitis, there is the high possibility that he is heading toward remission. There are some cats (few and far between) who suddenly don't need insulin any more, but for many of the cats that do attain remission, they usually require their insulin to be dropped gradually and eventually taper off down to 0.10u before going completely off insulin (this is the reason I suggested not dropping the dose by a full 1u).
 
OK, so he was getting 3.00. Now drop it to 2.5?
This sounds like a safer route.
I was wondering about the sudden removal of insulin...ah, the vets I've had...
So I will reduce it to 2.5, and give him his evening shot.
Since the vet's advice, I've been researching on this board and elsewhere, and nowhere do I see simply stopping.
I'm seeing reducing the dose, and more testing.
 
I read her Carl's comment regarding the bounce, and she agreed with it. She thinks he is having a Somogyi and had a seizure because of hypo. She said that in case he is going into remission, this allows him to do so, and gives him a fresh start with the insulin. She said that the protocol for a Somogyi is to withold the insulin for 3 injections.
Click to expand...

I'm happy she agreed with my comments....but I think she may have misinterpreted it. The word "somogyi" is way overused, here and by vets. It was a theory a doctor named Somogyi came up with a hundred years ago, which is not really accepted by doctors anymore. It was observed in humans, and supposed to have been caused by chronic overdosing of insulin. But it led to an upward spiral of BG numbers, in theory. It's never actually been studied, or found to exist, in cats. Most vets seem to use the term to explain what we call "bouncing". Bounces are not chronic. They are just something that happens by instinct in the cat's body in response to low numbers. They "go away" eventually as the cat becomes more regulated and used to what are actually usually normal BG values. Think about it this way. If a cat is used to BGs in the 200-400 range, then a BG like 100 is a "shock" to the system. It's "normal" for cats who aren't diabetic, but not to a cat that has been living with high BGs for weeks or months prior to diagnosis. We pretty much discount "Somogyi", at least in a literal sense, here.

Completely stopping insulin, for three cycles, I've never heard of. I've read here about people doing "rebound checks" by withholding or greatly reducing the dosage of insulin. They attempt to stop bounces from happening. From what I have read, it isn't usually successful, and they end up getting set back instead of improving things. Cutting off insulin completely comes with its own set of risks too. Ketones can appear, BG numbers can go high and stay high, and that can cause further resistance to insulin.

I think reducing, for now, to 2.5u is worth a try. It isn't a drastic reduction.

The best way to know how it is working is to test prior to every shot of course. But also try to test around the middle of either the AM or PM cycle to see what kind of number you see at nadir. Try to keep the dose consistent for 3-5 days, gather data, and then you can reevaluate things. Unless of course you see a really low number at nadir. If you see below 50 happen, it means most likely another reduction is needed. Because of the way Lantus works, it might take a day or two before the "depot" settles into the new dose level.
 
I gave him a 2.5 unit evening shot, and 2.5 at 8 AM.
I'm wondering if his numbers are dropping too fast.
So far we had:
7:45 AMPS 16.3
11:00 11.2

I know this isn't an especially low number, but it's lower than what his body is used to, so I want to avoid another hypo.
He's very sleepy and quiet, so should I give him a snack to raise his blood sugar a bit, and lower the evening dosage?
 
Nope. he's doing fine.
If you look at the chart I posted previously (which I may have updated to include mmol/L), he's nowhere near a hypo at 11.2
 
Hey, thanks, BJM. I'm jittery after Tuesday's hypo. That was so scary.

I just took another reading and he's at 8.9 mmol/L (160).
So his readings for today have been:

AMPS=293 +3=202 +5=160 +6=204

That said, I gave him some kibble at 11, and at 1, scared that he might be going too low, some sweet potato with Karo. If I didn't feed him (which I won't be doing in a couple of days, because I'll be back at work), and if he continues to heal, he could be going even lower. Should I be lowering the insulin, maybe not tonight, but tomorrow night?

Added: now at 2 (+6) he's at 11.4 mmol/L (204), as I gave him sweet potato with Karo. I'm worried that it may be a bit too soon for him to be getting lower readings right now, because his body isn't used to it. Is this a reasonable concern? I don't want to hinder his healing, but he's been high for a long time, and now is going low, and bouncing.
 
Its OK for him to move down towards lower nadirs slowly, however, you do want him to get below the renal threshold listed in the reference numbers, OK?


It'll help folks give you feedback if you could use our spreadsheet. Instructions here
And editing your signature to include your name, your cat's name, any other details you'd like to share, plus the insulin and a link to your spreadsheet would be very helpful, too.
 
I'm working on the spreadsheet/sig right now. cat_pet_icon

This is what I am wondering about - getting him lower a bit more gently, as he's had a pretty rough time.
So should I shave a bit off his evening dose?
 
Nope. I'd hold it nice and steady for a good 5 days to let him get used to it.

Maybe make your target nadir 100 - 150 mg/dL for now as you get used to the process of testing and shooting.

Then after you've got 1-2 weeks or so of solid data, you might shift towards the lower nadir between 50 - 100 mg/dL.
 
I'm just so nervous after the hypo.

He's been on 2.5 for 4 days now. I'm returning to work in 3 days, and won't be able to monitor him so I don't think I'll be able to concentrate too well. I thought he was going to die on Tues.
I know he's in "training" right now - I'm just worried about him going too low for what he can handle. On Tuesday the lowest he went, that I measured, was 4.8 and he had a hypo, I guess because he's not used to being low. I am living on pins and needles right now. All day he's had enough strength to walk over to his water dish, and then drinks from a lying position. I keep worrying that he's not doing great. Maybe it's the heat and humidity.
 
If its your regular shot time, test, feed, and shoot.

It'll take about 3 days for his numbers to settle down after the seizure incident.

Also, it may help to print out these instructions on How To Handle A Hypo. We use Karo/honey/glucose/syrup/high carb gravy to bring up the glucose level quickly in an emergency, using an oral syringe.

Sweet potato isn't going to do it for a hypo; it takes too long to digest. If they're canned in syrup, the syrup may be used.
Kibble takes too long to digest.

On your spreadsheet, could you make the notes column wider, please? That'll let more rows show in a view, even if one needs to scroll over to the comments.
 
Thanks again, BJM. I just also saw your advice about what numbers to aim for.
All this info helps a lot. I'm just being skittery because of what happened on Tuesday.
 
Your vet said it wasn't a hypo. Your cat may have some other issue causing seizures.
 
One vet at the hospital, the one who was very casual about hypos, got her vet tech to phone me and say that it wasn't.
The next vet who phoned me that evening said it sounded like it was.
 
Hmnn. Interesting.

I'd aim for the nadir to be in the 100-150 mg/dL range then, rather than going for 50-100 mg/dL for the time being, to ease back down to normal-ish numbers.
 
Thanks - I'm way more comfortable with that.
To achieve that kind of nadir, for the next 3 days I can do hometesting every few hours.
Then on Monday, when I return to work, how can I ensure he doesn't go too low? This is my big concern.
That's why I was wondering about changing the insulin.
 
Leaving food out for your cat to eat while you are gone is a good idea. That way, if he is feeling low, cats will often go eat some foods. Have we talked a bout cat food 'cicles yet? Plop can of food out onto cookie sheet, tray, non-stick muffin cups work really well. Freeze and pop out and store in a Ziploc bag. Pop one out before you leave for work and it will defrost during the day, providing your cat something to eat while you are away.

Lantus is a very gentle and smooth acting insulin with a nice long duration. Most of the other insulins are too short acting for a cat. Levimir is a possibility but you have not been using the Lantus for long. There are no guarantees that any insulin will not take your cat low.

Leaving extra food out while you are gone is one way to deal with the lower numbers.
 
Thank you Deb & Wink. What a great idea.
River lives with 6 other cats, and a couple of them would snarf that food down as soon as I'm out the door, but I think that if I'm really worried, I could leave River in the bathroom while I'm at work.

I don't know if I'm overreacting because of the seizure/hypo/whatever it was two days ago, but now I'm very worried about him going too low.
 
Deep breath, hold, release, deep breath, hold, release, deep breath, hold, release..................................... Repeat as necessary. Those deep breathing exercises can help to relieve the stress.

No one likes to see highs, but they are not as immediately dangerous as those really low numbers can be. HI is high and you simply go on and give the insulin and look for better numbers another cycle. It took time for your cat to become diabetic, it will take time to help the pancreas heal. You do the best you can, and hope for little signs of improvement along the way, like drinking less water and peeing smaller puddles in the litter box.

"Better too high for a day, than too low for a minute." is one of our sayings. It's another way of saying those lows can be an immediate concern and the high numbers are a longer term concern.

That HI could have been some residual effects from the high carb sweet potato or dry food.

You've come really far in such a short time. You only joined us here on the FDMB a couple of days ago. River is leading this sugardance, and we are following along. You'll get more even BG's eventually. It will take some more time. Hang in there. We're here for you.
 
Picknickchick said:
Ack...8 PM reading is just HI.
So high it doesn't register.
That's never happened.
This is so darn stressful.
Click to expand...
Couple of thoughts - did I see that you fed him karo syrup and kibble a few hours ago - that could have contributed to the high reading.....I meant to say something yesterday - according to the manufacturer- Orijen dry is between 18 and 22 percent carbs which is pretty high for a diabetic cat.

Hang in there - I know its frustrating that you can't just fix diabetes quickly - but it will get easier......

Em
 
Deb and Wink, Em :YMHUG:

Thanks so much, you are very kind. I'm just a ball of nerves after ketosis/pancreatitis/hooray some lows/oh no a hypo/bouncing.
I've been lurking on the boards for a while, reading a lot, but never felt the need to post, until now, and you guys are so great with your information and recommendations.

I didn't know Orijen was that high in carbs. Wow, that's unacceptable.

Thanks for your support. The advice about breathing is perfect. Actually, as soon as you mentioned that I could leave out frozen food, and I realized I could confine him to the bathroom if needed, life became a whole lot better. Like I could consider leaving the house without panicking.
 
If you decide to drop the Orijen, remove it gradually, about 20-25% per day so you can monitor the impact on the glucose safely.

Removing dry food may lower glucose 100 mg/dL!
 
Thanks, I will. The good thing is that he very rarely got any Orijen, because I don't believe in dry food for cats. I'm a raw feeder, but always have something else on hand in case I run out, and snowed in, etc. For my two eldest cats, River and his brother, I'd sometimes give them a few pieces as a treat, but very rarely gave them a meal of it.
So removing Orijen won't be a big deal, but for now, I am going to do everything that I normally do and not change anything, so as not to raise or lower the numbers.

I'll try remaining calm during tomorrow's testing and see where the numbers go. Wish me luck!
 
Good luck with the testing tomorrow! Let us know how it goes, and we can welcome you to the vampire club.
 
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