unusual curve - what should i do?

Hello everyone!

I've done about 4 or 5 blood curves and this one has been very different from the others.

9:30 am - 3.6 - before food (Smokey was fed after this.)

12:30 noon - 8.3

5:00 pm - 1.4

This last one has me majorly concerned. I wasn't sure what to do so I gave Smokey some food.

Any advice would be sincerely appreciated!

Thanks in advance, Rhonda

 

He's too low. Please test again, in case it was a bad test.

Do you have any Karo syrup? Give a couple drops.

What insulin are you using?
What dose?
What kind of meter?
What are you feeding?

The following may help.

We suggest using an inexpensive human glucometer with pet-specific reference numbers. One many of us use is the WallMart Relion Confirm, or Confirm Micro, which is also sold at American Diabetes Wholesale as as the Arkray USA Glucocard 01 or 01 Mini (same manufacturer - Arkray USA). It uses a tiny blood droplet and the cost is significantly lower for test strips (like $0.36 each).

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​

Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

 

Hello BJM and thanks so much for replying.

I'm sorry - I'm so new to this I didn't even think about providing specifics.

5.5 units of caninsulin twice daily.

Diabetic moist - 1/4 can each night. Diabetic dry crunchies - not sure how much - I use a pre-measured small scoop (likely 1/4 cup or so)- morning and a bit at night.

Rhonda

 

Hi Rhonda, any chance you are in Canada? That 1.4 has me concerned too. Could you put some honey or corn syrup(karo to the US) or regular syrup on a couple teaspoons of Smokey's regular food. Please test again 20 minutes after Smokey has eaten. We need to get him up higher.

Your dose is too high, but we'll talk about that once we have Smokey's numbers higher.

 

OK
I've private messaged a couple of folks because he is in hypo territory and I'm about to head out the door.

If you have some Karo syrup or honey, get it now and give him a couple drops.

Also retest him as it may be a bad test (one can hope)

If not a bad test, you're going to need to :
Test
If below. 2.7, feed 1-2 teaspoons of high carb food or regular wet food with some syrup/honey/glucose mixed in.
Wait 20-30 minutes
Re-test.
Repeat until rising steadily and above about 5.5 mmol/L (100 mg/dL)

 

Hello again.

After a bit of food it is now 2.6 - 20 minutes after food.

Should I still do the syrup?

Thanks Rhonda

 

That's still low, we'd like Smokey above 2.8. How about 1 drop of syrup on a bit more food?

 

See my post just before your most recent.

What meter?

I'm hoping a human meter.

 

Hello again.

I am in Canada & I am using a human meter - the Bayer Contour.

I did give him a bit more food and a bit of honey. He seems perfectly fine - are there any glaring symptoms of feline hypoglycemia? I'm sorry but I haven't had time to read the info BJM provided.

And a huge thank you and many hugs for being such a caring & concerned community! Your replies have meant so much to me.

Rhonda

 

Test
If below. 2.7, feed 1-2 teaspoons of high carb food or regular wet food with some syrup/honey/glucose mixed in.
Wait 20-30 minutes
Re-test.
Repeat until rising steadily and above about 5.5 mmol/L (100 mg/dL)

 

Great on the feeding. If you got to him fast enough you might have avoided the worst effect of a hypo. Good job. Here is a list of hypo symptoms.

When you get a chance, could you test again 20-30 minutes after he last ate. We want to make sure he's on the way up.

Also, I'd like to talk a bit about dose and food. 5.5U of Caninsulin is a high dose - what dose did you start at and how did you get to 5.5U? Unfortunately, we see way too many kitties here on the wrong food and too high an insulin dose.

 

Definitely need to reduce the dose - I think I'd drop it an entire unit to start.

Some reading once you're sure he's stable - Cat Info

 

Thank you, thank you, thank you.

Smokey is showing no symptoms of hypoglycemia so don't worry.

Thanks to both of you, he's all right. He's such a little trooper - but he's fine & I'll be retesting him shortly.

Hugs & furry head butts, Rhonda & Smokey!!!

 

Caution: syrup wears off fast!

And he can be asymptomatic right up until he starts seizing.

 

Wave and a head but from rainy Vancouver.

After you have the chance to read around and learn more about diabetes management of cats, you will be able to get your cat on track and possibly into remission. It does look like your kitty needs less insulin and if you change to a low carb food, with no crunchier he may need a lot less insulin.

Imagine what Banting and Best would think of their discovery being used to care for our pets.

 

I'll hang around until Smokey is in safer numbers. Looking for your next test result.

 

Hello from another Canadian... Oshawa Ontario.

1.4 says his dose is too high. I am glad you gave syrup but it wears off and he can drop low again. You will need to test often and monitor for a while until we get two tests over 2.8 that are a good hour from the last time he had high carb or syrup. So glad you are home testing!!!

Once he gets through this crisis we should discuss a better more cat friendly insulin..

 

I don't think my last post went through...I may have to write it again.

 

Can you quickly tell us the last test result? The rest can wait a bit.

 

Thank you BJM, both Wendys & Fast Eddie for your kindness & caring!

Smokey seems to be doing fine and I am shortly going to do another blood test. Actually, I feel comfortable enough to sit down and watch the Oscars with Smokey beside me.

Eddie, it isn't far from where I live in Toronto where insulin was discovered. The University of Toronto has a plaque commemorating their work. I don't think Banting & Best would have raised an eyebrow about their discovery being used on cats - I believe they experimented on diabetic dogs. But it's all good.

Thanks again from the bottom of my heart! I'll let you know how the next test goes!

Rhonda

 

Hello again.

16.2 - unbelievable.

I'm not sure what to think at this point! How can this happen? Impossible.

Rhonda

 

No, it isn't.
When the glucose goes very low, compensatory hormones kick in to raise the glucose by releasing glycogen, which can be broken down into glucose.
Perfectly normal, and be glad of it, or your cat would be gone.

These high response levels wear off in about 3 days or so.
If he's been having lows you didn't catch, he may not have much left in reserve, so you're very lucky he survived this time.

He is likely to be much more sensitive to insulin from this hypo experience. I'd cut his dose in half while we fill you in on better low carbohydrate nutrition options available over the counter, such as Friskies and Fancy Feast pates which may drop his glucose levels even further.

 

Thanks BJM!

So this leads me to my next conundrum/question - does Smokey get his insulin tonight?

Should I wait? - he's been getting insulin 2x daily. I don't want his blood sugar dipping again.

Thanks a lot,

Rhonda

 

Sorry BJM - I didn't see the second half of your response - it was cut off.

 

I'd only shoot half of what he was getting, due to the probable increased sensitivity and the dose reduction.

How late can you stay up to monitor him?

What don't you see?

 

BJ suggested you cut his dose in half since the previous dose is clearly too high.

Tomorrow call your vet and tell him what happened. And discuss a better insulin with him like lantus, levemir or prozinc. They aren't as harsh, are easier to manage and have a good chance of remission!

 

And if you're in Canada, you can walk into a pharmacy and purchase either Lantus or Levemir without an Rx.

We've got a Lantus/Levemir protocol based on an article written by Dr Rand of the U of
Queensland and Kirsten Roomp (?of the Diabetes Katzen forum?). They pioneered use of Lantus in cats and it has a good chance of remission if followed carefully.

 

I would give insulin tonight, but a lot less. From looking at your first post, it looks like Smokey was 3.6 before his AM shot? For future reference, we ask new people to not give a shot if kitty is under 11.1 at shot time.

Without seeing the history of the previous curves, or knowing how Smokey arrived at the 5.5U of insulin, I would recommend a much reduced dose tonight, maybe 2 units or 2.5? If you are interested in sharing your test data with us so we can help provide more suggestions on dose, we use spreadsheets that you'll see in people's signature. To create a spreadsheet, here are the instructions.

Cats are lucky in it is possible for cats to go into remission. With the proper diet, a better insulin, and following a dosing protocol this is possible for Smokey. Cats do best on low carb canned wet food or raw. You do not need to feed veterinary foods which are mostly of not great quality and are expensive. Here is a list of commercial off the shelf wet foods. You want to look for something under 10% carbs. As BJM says, many people here use Friskies or Fancy Feast Pates, Wellness is also popular but there are others on the list. However, DO NOT switch foods unless you are doing regular blood testing as a change in foods away from dry can make a drastic difference. We had one member who recently did a dental for her cat and switched off dry food and within 24 hours went from 5.5U of Levemir to remission. It was a pretty scary 24 hours!

And as Oshawa Wendy suggests, talk to your vet about a better insulin. We started on Caninsulin but that insulin is really a dog insulin. It doesn't last long enough on most cats and has really steep drops and rises. That could be part of what you saw today. And cats on Caninsulin have a much higher percentage of hypo incidents. I saw one paper that said 30% of cats on Caninsulin had at least one hypo. Lantus and Levemir are available without prescription in pharmacies in Canada. Let us know if you want to go that route, we can help with dosing as we have much more experience with those insulins for cats.

 

Thank you so much - everyone. BJ, both Wendy's (Vancouver & Oshawa..~smiles~) & all other concerned feline lovers!

I appreciate all your advice and will speak with my vet tomorrow about everything.

It's interesting to find out Caninsulin is a product for dogs but I always wondered about the name - now it makes sense!

Thank you for the advice about the other insulins - although cost doesn't matter when something so important as a beloved pet's health is at stake! - it's good to know that there are less expensive options available. It all helps in the long run - and it seems to be a better option nonetheless!

Is it too much to offer hugs to you? - you don't have to answer that it's a rhetorical question...lol! - because if we met in person that's what I would do - your caring is inspirational. Thank you again. I wish the world could help each other the way you helped me.

Rhonda

 

PS I gave Smokey 2 units of insulin about 15 minutes ago. I will check his blood again shortly.

Also, the info re the food was very interesting and I plan to revise his diet!

 

Why yes, {{hugs}} are allowed.

If you plan to change his diet, do so gradually to avoid diarrhea, nausea, or vomiting. Change about 20-25% per day. If you see any signs of GI upset, back up a day and hold it for another day or two. Given that you are feeding both dry and canned, I'd start with the canned food switch first, then slowly phase out the dry food after that.

Very important: you must be home testing when you change food, as the glucose levels may drop as much as 100 mg/dL (5.5 mmol/L). That is another reason to do it gradually, so that you have time to adjust the dose based on the lowered glucose level.

 

Thank you.

I will, of course, monitor Smokey's blood levels as his food is adjusted. It makes perfect sense now that you've explained.

This has been such a huge learning 'curve' for me - as much as it's been a 'curve' for Smokey.

Good night for now...

Rhonda