? Why does this happen??

Liane Jacobson

Liane Jacobson

Member
Sometimes Faith will show low (between 54 and 47) on her cgm but she is acting fine, she has eaten a moderate (and at times) high carb snack. Today she started at 7:30 at 67. She ate 3/4 of a can of Tiki cat grills. She alarmed again at 8 in the 50’s. Gave her some moderate carb treats (2 tbs), then gave her some “regular” cat food w/13% carbs an hour later when she alarmed in the 40’s. Long story short, her cgm has not risen above 63 and she has been eating/grazing almost the entire time. She isn’t wobbly, ataxic, drooling, acting strange- she ate, used the litterbox, went back to see if I’d put any new treats out. Ate some freeze-dried beef, took a nap. Why is this happening?
And yes, I have checked her with the meter; it says she was 57 at 8:30 and 53 at 10. But she is acting normal. She does this every so often.. never acts as if she is hypo.. then suddenly she jumps to 200.

I’m just confused…
 
I think it's rather rare when there are hypo symptms, and it's a good thing, because hypos are very dangerous. You should definitely act when she is low like that, though, even if she is acting normally: feed her a small amount of moderate carbs if she reacts usually, then re-test after 20-30 mn, and repeat until she is in safe numbers for at least an hour. If you can, check those numbers with a handheld meter, as the Libre has a delay and can give falsely low or high numbers.
I like to read and re-read this sticky and the links at the top of it, too:
Don't Panic! or How to Handle Low Numbers
 
cecile & bella said:
I think it's rather rare when there are hypo symptms, and it's a good thing, because hypos are very dangerous. You should definitely act when she is low like that, though, even if she is acting normally: feed her a small amount of moderate carbs if she reacts usually, then re-test after 20-30 mn, and repeat until she is in safe numbers for at least an hour. If you can, check those numbers with a handheld meter, as the Libre has a delay and can give falsely low or high numbers.
I like to read and re-read this sticky and the links at the top of it, too:
Don't Panic! or How to Handle Low Numbers
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Did you read the post? She has been fed until she will not eat anything else. She has been eating since 7:30 am. She has eaten 1 3oz can of cat food, 1/4 cup of freeze/dried Stella &chewys beef diet, 3 tablespoons of catnip &chill shameless pets treats and 4 tablespoons of Purina one sensitive stomach. And yet her sugars look like she has not been fed at all. She does this at least once a month- I took her to the vet and they charged me a huge amount do a curve and give glucose and watch her stay below 60 only to tell me they don’t know why she is doing this. I was hoping for someone to have real life experience with this.
 
No need to be rude. Yes, I read your post, I was trying to help. What you did is good. Next time feed her smaller quantities so she will still be hungry. when you say you checked the meter, is it a hamdheld one?
What are her numbers now? Can you update your ss if you have a minute?
I will tag other members so you have more answers.
@Wendy&Neko can you help Liane with that?
 
cecile & bella said:
No need to be rude. Yes, I read your post, I was trying to help. What you did is good. Next time feed her smaller quantities so she will still be hungry. when you say you checked the meter, is it a hamdheld one?
What are her numbers now? Can you update your ss if you have a minute?
I will tag other members so you have more answers.
@Wendy&Neko can you help Liane with that?
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I apologize for getting upset. I’m just very frustrated because I called the vet and their suggestion was bring her in if I think she needs it- I’M CALLING BECAUSE I DON’T KNOW WHAT TO DO!!! This crazy cat does strange things sometimes and no one can tell me why. Yes it’s a handheld meter; was not aware there was anything other than cgm and handheld. It’s a relion I’ve had for years, since her first dx. If she would act “off” I would have a better clue, but she is her usual self- eating any goodies I offer, napping in the sun on the bed, using her litterbox and drinking water- currently hiding because I gave her a teaspoon of maple syrup and she haaates it, and it didn’t even bring her sugar up… I’m just so lost…
 
cecile & bella said:
No need to be rude. Yes, I read your post, I was trying to help. What you did is good. Next time feed her smaller quantities so she will still be hungry. when you say you checked the meter, is it a hamdheld one?
What are her numbers now? Can you update your ss if you have a minute?
I will tag other members so you have more answers.
@Wendy&Neko can you help Liane with that?
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She has apparently gotten over her episode. She is finally up to 101…her spreadsheet is updated.
 
Human meters give blood glucose readings on a cat that are lower than the true lab value. Especially for numbers below 100 or very high numbers (this has to do with allowable variance in a meter). Libres not only have this false reading of cat values but in addition reads interstitial fluid rather than blood so there is an additional variance and also a time lag between blood value rising (or falling) and being read by the meter.

that’s why
 
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It’s possible that the jump is either the cgm catching up with the blood that is catching up with all the food. It’s possible that once the number is above 100 it will have a smaller variance and be closer to a real number (although still off because it’s not designed for cat blood)

I can’t tell you a relion variance but for the AT below 100 it is +/- 15 from the true number (bc it’s designed for feline blood)—so you can see how 70 could be 85 or 55. Once above 100 it’s +/- 15%. These numbers of how far off true value are likely greater for a human meter
 
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I completely understand, it IS scary.
Numbers above 50 are safe, even though they are nerve-wracking!
I was asking about the meter because your SS mentions a Libre.
When did you give her the syrup? How long ago, I mean? We are all in different time zones so it's difficult to calculate, sometimes.
I see you skipped today, she should stay higher now.
As for the vet, I think as long as she does not have symptoms and is over 50, she is safe so that would explain their answer, I suppose?
I hope you can both relax now :bighug:
 
SmallestSparrow said:
In other words your cat had a blood value likely higher than what you read on the human hand held and the human CGM
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Interstitial, not intestinal. Huge difference. I understand how meters work. Nothing here tells me why she had a 4 hour period when food did nothing to her blood sugar. And despite constantly hearing how “incorrect” the cgm is, it has strangely been comparable to the meters used by two vets offices. Please don’t offer opinions if you have no experience in using a cgm. You are not helpful.
 
cecile & bella said:
I completely understand, it IS scary.
Numbers above 50 are safe, even though they are nerve-wracking!
I was asking about the meter because your SS mentions a Libre.
When did you give her the syrup? How long ago, I mean? We are all in different time zones so it's difficult to calculate, sometimes.
I see you skipped today, she should stay higher now.
As for the vet, I think as long as she does not have symptoms and is over 50, she is safe so that would explain their answer, I suppose?
I hope you can both relax now :bighug:
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Oh ok.. I got the cgm because the cat was literally disappearing after testing.. between the syrup and 2 meter checks, she has vanished. And I swear, I won’t find her until she is ready to be found..
She got the syrup before I called the vet at 10 am. It still took over an hour before she began to respond normally. I just do not understand why she does this- it’s new to this round of insulin dependence and (since I’m an RN) I tend to freak out.. also because she is 23… and I’m not going to do well when she finally does wear out and leave me… thank you.
 
Liane Jacobson said:
Interstitial, not intestinal. Huge difference. I understand how meters work. Nothing here tells me why she had a 4 hour period when food did nothing to her blood sugar. And despite constantly hearing how “incorrect” the cgm is, it has strangely been comparable to the meters used by two vets offices. Please don’t offer opinions if you have no experience in using a cgm. You are not helpful.
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Liane Jacobson said:
Interstitial, not intestinal. Huge difference. I understand how meters work. Nothing here tells me why she had a 4 hour period when food did nothing to her blood sugar. And despite constantly hearing how “incorrect” the cgm is, it has strangely been comparable to the meters used by two vets offices. Please don’t offer opinions if you have no experience in using a cgm. You are not helpful.
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sorry I didn’t police the spell corrector. As mentioned before your approach could be nicer. Two is a trend pointing to a common problem. I’m a physician who believes in science. Ymmv.
 
Liane Jacobson said:
It still took over an hour before she began to respond normally.
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You said she acted normally the entire time. If by “respond normally” you are referring to the meter reading, it is a number ON A HUMAN meter. There is lag time between food in system and glucose rise—cats have a different response than humans. Since you’re an RN you understand why human meters of any sort read significantly lower than a cats true value and the different glycemic response in species . And that we treat the patient not the lab. And that labs and X-rays tend to lag what’s happening in the patient. I get that you’re stressed and worried about your cat. It sounds like they were acting normal and most likely were not hypoglycemic—but if in doubt it’s nice that your vet offered to work them into their schedule and I’d take them up on the offer for your peace of mind. Perhaps get a meter designed for pets to double check the Libre rather than the relion. The strips are more expensive but you wouldn’t use them that often and it would give you better peace of mind.
 
:confused::confused::confused:So you don’t advocate for clients to use cgms? Under any circumstances? How many years have you been practicing? I’m an RN with 30 years experience, a good 10 of it in endocrinology. Guess I have no idea what science is about!
 
Liane Jacobson said:
I have checked her with the meter; it says she was 57 at 8:30 and 53 at 10.
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Do you mean 8:30am and 10am or +8:30 and +10? We all use + times here as we are all from around the world and different time zones. When you do double check with the meter - good idea by the way - please put add those human meter values in the spreadsheet too. We some some variability in how much different the Libre and meters, so it's good to know what it is for your Libre and your meter. What type of meter are you using?

Is she still getting some of the Young Again food as part of her regular diet?

Sorry for the many questions, but there are many moving parts with feline diabetes, from food to types of meters and what values you are seeing.

Using a human meter, I've tested several not diabetic cats in the low 50's, and even one in the upper 40's. It's a normal range for a cat not on insulin. We don't want cats on insulin going as low as the 40's as it gives no room for error.
 
Liane Jacobson said:
:confused::confused::confused:So you don’t advocate for clients to use cgms? Under any circumstances? How many years have you been practicing? I’m an RN with 30 years experience, a good 10 of it in endocrinology. Guess I have no idea what science is about!
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If you mean me, I treat humans. CGMs and human meters are designed for human blood. Not cat blood. I hope you get some sleep
 
Wendy&Neko said:
Do you mean 8:30am and 10am or +8:30 and +10? We all use + times here as we are all from around the world and different time zones. When you do double check with the meter - good idea by the way - please put add those human meter values in the spreadsheet too. We some some variability in how much different the Libre and meters, so it's good to know what it is for your Libre and your meter. What type of meter are you using?

Is she still getting some of the Young Again food as part of her regular diet?

Sorry for the many questions, but there are many moving parts with feline diabetes, from food to types of meters and what values you are seeing.

Using a human meter, I've tested several not diabetic cats in the low 50's, and even one in the upper 40's. It's a normal range for a cat not on insulin. We don't want cats on insulin going as low as the 40's as it gives no room for error.
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8:30 am- +11 hours and 10am- +12 hrs. Relion meter. She still gets the young again mixed with ziwi beef and whiting (she has gotten extremely picky and she eats more YA when mixed w/ziwi). She just discovered the Stella &Chewys dehydrated beef feline diet pellets, I mostly feed it when she is hypo because she will ALWAYS eat it. On the regular she gets the YA and ziwi mixed, dusted w/miralax free feed, 2-3 cans of wet food daily (she eats more dry food if she is refusing her canned) First can of wet food has Porus One mixed in with a pinch of miralax and an extra can of water; she has a water fountain that I add 16 oz to every other day and she currently uses the breeze system and saturates a multicat pad every 3 days (plus tends to pee over the entryway, so puppy pads are changed daily in front of the box. I add an extra can of water to every can of wet food plus she drinks a lot.
I freaked out because she will drop to the high 50’s at times; usually I give 2 tablespoons of her catnip and chill treats plus some ziwi or dehydrated beef and she normalizes within 20 minutes of eating. She also gets a bedtime snack- when she saw that my dogs got a “treat” at bedtime (they take anxiety meds), she pretty much demanded to also get a treat, so I give her a couple of freeze dried nuggets. What has freaked me out is that she will go low, eat her regular meal, stay low, get a carby treat, continue to be low or go lower, keeps on eating- she has done it twice, both times it lasted around 4 hours. It makes no sense when nothing changes but her sugars will not go up and she eats pretty constantly through the episode. The first episode I gave maple syrup early, ended up giving it twice. This episode I just knew she was going to start coming up, so I held off. And still ended up giving it. I just wish someone has dealt with this before. This cat has been with me 20 years.. she is my baby..
 
Liane, I say this nicely, but I think if you would like people to help you, you really need to stop answering us in such a mean way. I get it, we all love our cats and are stressed at times. we all have cats who might not be doing well, we answer to help you. You are not the only one who has experience in medicine, Colleen is a physician, I am too, some of us are vets, nurses, but we all have diabetic cats and we all have experienced being scared with a cat who goes low and we did not know what to do, and that is why we are trying to help you here.
We are all telling you the same thing, basically: you cat was safe the whiole time. Nobody knows why she did not go up with food, but what counts is that she is safe, she went up eventually.
I will stop answering you now because the way you respond makes me feel bad and I honestly do not need this kind of interaction, but I hope you find peace and that Faith will be well.
 
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Faith's dose needs to be reduced by 0.25 units. Since you are feeding dry food, you cannot follow the Tight Regulation Protocol for dosing, which has feeding an all low carb wet or raw diet as a prerequisite for safety. The option we use here for people feeding some dry is SLGS for dosing. It is a time proven dosing method. But it does mean the dose needs to be reduced if she goes below 90, which she has been doing on this dose. With a lower insulin dose, hopefully you won't get those drops and jumps up in numbers. Since you are having a hard time getting her numbers up even with higher carb food, that is also a good reason to lower her insulin dose.

What she is doing with the jumps is what we call bouncing. Not sure if anyone gave you the definition.
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

FWIW - I too had a cat (Neko) with CKD, though further along in progression, and combined with heart and GI issues. I asked Neko's IM about those high numbers and it's impact on her kidneys. He said that temporary high numbers were not a problem, just the prolonged high numbers.

Putting my moderator hat on: we all here have or have had diabetic cats. Some even multiple diabetic cats, and some diabetic cats with a lot of complications. We understand the stress handling a diabetic cat gives people. It is real. We have all been there, we really want to help because we remember what it was like for us too. A gentle reminder: FDMB Guide to Posting and Etiquette
 
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