Why is Biscuits bottoming out now?

[Karen & Biscuits]

So, since Biscuits spent 6 days at the vet and bottomed out at 25 last Monday after I got her home, and then had a big spike the next day at 679, she has stayed within more reasonable numbers since then. This morning when I took her glucose reading, it was at 60, which scares me because she had already had breakfast and her meds. I did not give her any insulin because I may not be home this afternoon and I can't watch her then. I did give her a few Fruitables treats to bring it up slightly and usually they don't mess with her sugar too much but while I'm glad that her sugar is staying in the lower numbers, I don't understand why it's going so low now. Is it possible that the pancreatitis has kind of done a reset on her diabetes? It's not making sense to me because she's eating the same as before. I'm rather confused right now. What are your thoughts?

 

[Christie & Maverick]

With Levemir, most kitties typically onset around +4 and nadir around +8, but sometimes you'll find that the preshot number is the nadir, or even sometimes a little beyond. My Maverick is on Lev and has had quite a few cycles over the years where he carries on into the next cycle and nadirs at +14 or +15. So, knowing that kitties on Levemir can actually reach nadir at preshot or a little after, sometimes getting some spot checks at +10 or +11 can keep you out of trouble, since it will tell you if numbers are continuing to drop or staying flat by preshot. As for why this is happening, it’s just Biscuits’ way of telling you she doesn’t like 3.5u any more, at least for the time being.

That 60 this morning earns a reduction, please go down to 3.25u for this evening’s dose. Have you been able to grab another test since then?Even though you skipped, it would be worth checking a few BG tests in this cycle, just to make sure she has started rising, while not as scary as lows that you had on the 5th, you don’t want her lingering too long under 68, so some higher carbs may be needed depending on what additional tests read.

How has Biscuits been doing with the meds and her appetite? Looks like from your past post, you certainly have your hands full

 

[Ale & Bobo & Minnie (GA)]

I would I also encourage to start getting a true amps, which means a test where she hasn’t had any food for at least 2 hours so you can really see where her bg is before giving insulin. How long after she ate you got the 60?

once you have a chance, can you please start plugging the numbers into the spreadsheet?

 

[Karen & Biscuits]

I would I also encourage to start getting a true amps, which means a test where she hasn’t had any food for at least 2 hours so you can really see where her bg is before giving insulin. How long after she ate you got the 60?

once you have a chance, can you please start plugging the numbers into the spreadsheet?

The spreadsheet is up to date, my old meter died so I had to start over with a new one, which is why the numbers start in May. If I can get a new battery I might be able to add the info from before May but it's hard to say.
The morning reading is always at 10:30 am. She eats at 7:30-8:00 am every day, so there is definitely a 2 hour gap between eating and taking her glucose reading. Therefore, the 60 reading was at least 2 hours after eating today, which is why I'm questioning why she's bottoming out. She has Dr. Elsey's clean protein dry food for kibble, she hasn't been eating as much of it since her vet stay last week, and also getting 1/3 of a can of Weruva Cat in the Kitchen wet food variety pack. She shares one can with her brothers, one of which is also diabetic. If the boys don't finish their food, she usually goes to clean it up, which means she gets more than a 1/3 of a can, but that doesn't happen every day. It's usually based on flavor and Skittles is not fond of all 4 flavors, and neither is Purrcey. She will eat the ones that don't get finished almost every time.
Hope that helps

 

[Karen & Biscuits]

With Levemir, most kitties typically onset around +4 and nadir around +8, but sometimes you'll find that the preshot number is the nadir, or even sometimes a little beyond. My Maverick is on Lev and has had quite a few cycles over the years where he carries on into the next cycle and nadirs at +14 or +15. So, knowing that kitties on Levemir can actually reach nadir at preshot or a little after, sometimes getting some spot checks at +10 or +11 can keep you out of trouble, since it will tell you if numbers are continuing to drop or staying flat by preshot. As for why this is happening, it’s just Biscuits’ way of telling you she doesn’t like 3.5u any more, at least for the time being.

That 60 this morning earns a reduction, please go down to 3.25u for this evening’s dose. Have you been able to grab another test since then?Even though you skipped, it would be worth checking a few BG tests in this cycle, just to make sure she has started rising, while not as scary as lows that you had on the 5th, you don’t want her lingering too long under 68, so some higher carbs may be needed depending on what additional tests read.

How has Biscuits been doing with the meds and her appetite? Looks like from your past post, you certainly have your hands full

Thanks Christie - would you mind refreshing my brain about the nadir. I sort of understand it but maybe I'm wrong in my thinking about it. Is that when they kind of level out several hours after a shot and it stays in that range for awhile? Her sugar is so whacked out that I get different readings continuously. However, as I said in my initial post, since her bout of pancreatitis and that bottoming out and then the giant spike the next day, she seems to hover in the 100-300 range, something that she hasn't done before. I find this weird but also good, because it's not getting into the 400 and up range now. Her diet has not changed except that we're being much more vigilant about her getting into the food that belongs to my roommate's cats. It's not that we didn't watch her before all this happened but we're just being more cautious now because she tends to be sneaky. If she goes into the kitchen and lays down on the floor, we now know that she's plotting a snack LOL. She won't touch it if anyone is in the room with her but if we all are doing our own thing and someone notices her in the kitchen, we shoo her off because we know she wants Crook's food (he's my roommate's cat). He doesn't like it when Purrcey eats his food and he will sometimes attack but he's gentle with Biscuits, so it's up to us to monitor this more closely.

To answer your question about her meds and appetite, she's doing fine with eating but meds, not so much. I usually have to get her pills mixed into some food and scoop it up with my finger and let her lick it off that way. It takes several tries but eventually she gets it. If I just mix it into the food, and let her eat by herself, she licks around the meds LOL. She's not stupid, that's for sure! I'm trying to avoid giving her treats with her meds for obvious reasons and if the sucralfate pill wasn't so big, it would be easier to get into her that way. It's a battle but I'm going to make sure she finishes her meds because I sure can't risk another round of this mess with pancreatitis. She drained me financially with this last one and now I'm scrambling to find funds for food and litter for the rest of the cats that are in my cat house. She and her brothers live in the house with me and my roommates but the strays and ferals have their own cat house in the back yard and she does not interact with them at all. Just praying none of the outside cats get sick because mama aint got the pesos for that right now LOL. So far, we're good!

 

[Christie & Maverick]

Depending on how much left of the meds you have you could look into Sienne’s previous suggestion about compounding the medicine. Yeah that sucralfate is tricky, when I used it for one of my cats some time ago, I was lucky enough to get it already in the liquid form from the vet.

here are a few of the terms as a refresher

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose

So that would mean from last night’s shot, and the tests we can see, Biscuits hit her nadir at this morning’s preshot, which was that 60.

 

[Karen & Biscuits]

Depending on how much left of the meds you have you could look into Sienne’s previous suggestion about compounding the medicine. Yeah that sucralfate is tricky, when I used it for one of my cats some time ago, I was lucky enough to get it already in the liquid form from the vet.

here are a few of the terms as a refresher

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose

So that would mean from last night’s shot, and the tests we can see, Biscuits hit her nadir at this morning’s preshot, which was that 60.

Thank you for that refresher - now it makes sense again. As for the meds, she has about 12 pills of the sucralfate left because they are split in half for each dose. The amoxicillin has only 5 pills left and that one she takes a bit better if I give it to her buried in food from my finger. Not sure why she prefers it that way but whatever works, right? I will ask the vet tomorrow if he thinks we should continue with the pill version of sucralfate or if he has the ability to prepare a liquid for her. Our regular vet is back tomorrow so I might make progress faster when he's around. He had a sub working and while he was sweet as could be and did a fantastic job with Biscuits, he also hasn't dealt with her before this latest episode, and was kind of tossed into a serious illness with her, so I think the original vet will have a better idea of what he's dealing with and what might work better for her as well. I will definitely check it out. So far she's doing fine today, thankfully.

 

[Ale & Bobo & Minnie (GA)]

I only see an empty spreadsheet on the Biscuits 2023 tab @Christie & Maverick can you see it?

For the amps and pmps, can you start testing her before she eats and making sure she hasn’t eaten for 2 hours?

 

[Karen & Biscuits]

I only see an empty spreadsheet on the Biscuits 2023 tab @Christie & Maverick can you see it?

For the amps and pmps, can you start testing her before she eats and making sure she hasn’t eaten for 2 hours?

The spreadsheet is current, but not from the beginning. My old meter died so I wasn't able to enter the info from the beginning of the year. It starts in May so you just need to scroll down a bit to see the current readings.
I just did her readings a bit ago, she ate at 8 am and I took her glucose at 10:30 this morning and she was at 73, so more than 2 hours after she ate. I'll try to take it tomorrow before she eats to see where we're at. I get busy with feeding all the cats in the morning and I tend to forget about taking her sugar then until it's time for her pre-shot reading.

 

[Ale & Bobo & Minnie (GA)]

Got it!

After that 60 yesterday, she earned a reduction so the evening dose should have been adjusted to 3.25. Anytime she drops below 90 on SLGS she earns a .25 reduction. She would get another reduction this morning because of the 73 so this morning dose should have been 3. She’s earning reductions back to back so I think what’s happening is the dose is too high for her but you need to adjust it in .25 increments. Let’s see what happens today since you gave her 2.

 

[Karen & Biscuits]

Got it!

After that 60 yesterday, she earned a reduction so the evening dose should have been adjusted to 3.25. Anytime she drops below 90 on SLGS she earns a .25 reduction. She would get another reduction this morning because of the 73 so this morning dose should have been 3. She’s earning reductions back to back so I think what’s happening is the dose is too high for her but you need to adjust it in .25 increments. Let’s see what happens today since you gave her 2.

I did give her 2 units this morning as she didn't eat much and I was worried about her bottoming out as I had to leave for a couple of hours. I got new syringes and they don't have 1/2 unit markings on them so it was hard to figure out where the .25 was as my eyeballs aren't that great. So far she's doing fine though. Which reminds me, what kinds of syringes do you use for your kitty? Mine are U-100's which is what the vet said was needed for Levemir, but Skittles is on U-40's for Vetsulin. Is there a "go to" syringe that most people use here? The ones I use for Biscuits are Ulticare Vet Rx 3/10cc 8mm and 31 gauge. Usually they have 1/2 unit markings on them, but I wasn't able to find them in stock and Chewy was being a pain about contacting my vet so when I was down to 3 syringes I finally gave up on Chewy and ordered from Amazon where a prescription isn't needed and ended up having to get the whole unit markings because that's all they had. For Skittles I normally use the Covidien Monoject 29G with 1/2 unit markings but they are getting harder to find. I really like those but had to go with a different one recently called Branzig, which are a lot lower quality and make it harder to dose correctly because the syringe plunger moves too easily, there is zero resistance which requires me to be very careful before touching it or I lose some of the insulin. We make it work but it can get frustrating. Just curious if there is a recommended syringe for both types that people tend to use here.

 

[Ale & Bobo & Minnie (GA)]

Folks on Vetsulin use different syringes I believe than glargine/Lantus because of the dosage so there isn’t one syringe that works for all insulin types I’m afraid. I’ve only ever used Lantus and I used Walmart ReliOn 1/2 unit marked syringes. The only down side is that you have to buy at in person at Walmart because they won’t ship them.

 

[Karen & Biscuits]

Folks on Vetsulin use different syringes I believe than glargine/Lantus because of the dosage so there isn’t one syringe that works for all insulin types I’m afraid. I’ve only ever used Lantus and I used Walmart ReliOn 1/2 unit marked syringes. The only down side is that you have to buy at in person at Walmart because they won’t ship them.
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Isn't that a U-100 syringe though? My vet told me that Vetsulin has to be U-40 as that's what is written on the vial, so that's what we use. I used to get the Reli-on syringes for Biscuits when I lived in Georgia but up here, the ones I need are not available, which is why I order the Ulticare ones, which was actually a little better because of the way they are marked (except for this latest box, which didn't have the 1/2 unit markings). For Skittles being on Vetsulin I've always used only U-40 syringes and for Biscuits, the U-100's because she's on Levemir.