Still new - when is too low for insulin?

Hi everyone,

I just did a blood glucose test on Callao before her 7:30 pm insulin shot. It is surprisingly low (for her): 251 mg/dL. You can see her recent values over the past week in her SS in the signature. I realize 251 mg/dL is still high, but I'm used to seeing numbers around 600 mg/dL before her insulin dose. Should I still give her 1 u at 7:30 pm? We're still quite new to this, so I just want to be sure. I left a message for her vet, but I'm not sure I'll get a response at this hour. Does anyone out there have strong feelings or advice they'd like to share?

Thank you all!

Cheers,
Meg and Callao

 

As long as you have plenty of test strips and some high carb food or Karo in case you need it, I'd shoot the 1U dose

Plan on getting a +1 and +2 test in tonight too in case she has a dive in mind

 

What insulin are you using?

 

Hey Meg - when you get a chance, could you add some more information to your signature? Things we like to see are; Insulin type, meter type, date of DX, any other illnesses, food type, age of Callao and anything else you think would be helpful to know. Just click on your name on top right corner (next to your inbox) and then click on signature. Thanks.

 

Tuxedo Mom, we're using Lantus glargine. It's long acting, and we've only been giving 1 u in the evening and started another 1 u in the morning yesterday and today with her vet's approval.

Merlin, certainly! I am still getting up to speed on protocol around here. For now, insulin type is Lantus glargine, 1 u twice a day, AlphaTrak 2 meter, diagnosed January 8, also has chronic kidney disease, currently on Hills k/d dry food (trying to switch to a lower carb but equally low phosphorus wet food with this diagnosis), she's 6.5 years old. I'll add this to my signature this weekend.

 

I also use Levemir. From what I can see it has only been about 8 days since you started using insulin??

It can take a while in the beginning for the "depot" to build up and for the kitty's body to start reacting to the insulin. If my assumptions are correct then it is possible that the insulin is finally starting to do its work and start bringing the numbers down.

 

I don't give dosing advise but you could post your question on the Lantus/Levemir forum and there are many experienced people there who could offer an opinion. Here is the link to that forum:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

You can also put a "?" icon in your title to get more attention.

 

One of our members who lost their dear kitty recently had a great list of LC/Low Phos foods as part of her spreadsheet

Look along the top for LC/low phos and you should be able to find something to replace the K/D with.....getting that out of the picture will really help with the diabetes control

Another option is to use a phosphorus binder like Aluminum Hydroxide that keeps the body from being able to absorb the phosphorus in the food to begin with, but it's generally saved for later stages of CRF

 

Just an update... after my original post, I waited 45 minutes and rechecked her blood. This time it read 301 mg/dL (read 251 mg/dL 45 min prior). With this, I decided to give her normal dose of insulin (1 u Lantus glargine). It's true that we've only been on insulin for 9 days, so her body is still adjusting. Though I thought about skipping a dose or giving a reduced dose, I also realize it is good that her numbers are far less than 600 today, and it could be so due to the regular insulin doses. Also, I promised my vet that if I was home testing, I would avoid making changes without her approval. At this point in the evening, Callao's numbers are holding stead in the low 300's. I think I'll ease up on the freaking out for tonight.

 

If she's at half the BG levels you are used to seeing, at least that's something. Callao's pic is so cute. She looks like a kitty Mona Lisa with her paws folded in her lap like that. There's even a hint of the famous Mona Lisa smile

Chris, thanks for the link to the LC/Low phos foods.

 

Another update: We started this morning off at 601 mg/dL, so I gave her normal morning dose. This evening she was at 357 mg/dL so I gave her normal evening dose. Now, two hours later, she is at 59 mg/dL. !!! I took away her low-carb wet food and refilled her high carb dry food, which she woofed down. She's acting pretty normal, but a bit lethargic. I'll check again in ~15 min while closely monitoring her in the meantime.

Are numbers always this crazy??? This is super stressful!

 

Wow....that's a heck of a drop!! One thing you might try to remember though...when you get really crazy readings like that, you might want to immediately recheck to make sure it's not a wonky test strip

Do you have some high carb canned food like Fancy Feast Gravy Lovers? We don't really like to use dry kibble to bring their numbers up because it takes too long to break down and "kick in" and then it takes too long to clear out of the bloodstream again

With the Gravy Lovers, we just pop the top, push it back down and "squeeze" the gravy into another bowl and give a teaspoon or two at a time until they're above 68 again on the AlphaTrak....and then continue testing every 20-30 minutes to make sure they stay up

If that 59 was a valid test, she's earned a reduction too since you're using the AT meter, so you'll need to go down to .75U for her next shot

 

Her next reading (+2.5) was 60 mg/dL, so it's not just a wonky test strip. She's still eating and acting normal but a little sleepy. I think the only possibly high carb wet food I have is Fancy Feast Broths. I have no idea what the carb levels are in that though. I'll try it anyway and retest in 15 min.

 

The "creamy" broths I think are higher carb than the "clear" broths but I'm not sure

Next time someone goes to the store, get some of the "Gravy" foods to keep in your "hypo" kit...You should also always have simple sugars like Karo/honey/syrup in the house for times when you really need to get their numbers up fast....or if (Heaven forbid) she were to collapse from being too low and unable to eat on her own so you could rub it on her gums

That dry food probably hasn't had time to breakdown and get into her body yet so she hasn't come up much...will watch for your next test

 

All I have are the clear broths. I have honey in the cabinet that I planned to use for any emergencies. I also just realized that her laxatone is basically corn syrup, so gave her about a toothpaste sized amount of that. Trying to wait a few more min before testing. Thanks for sticking around!

 

Yeah it really doesn't do much good to test too often since it takes some time to get the carbs broken down and into the bloodstream, but it sure takes the years off us beans waiting!!

 

Alright, just retested twice... first time read 78 mg/dL, but then I realized that I poked myself and may have been reading my blood and/or hers or some weird cocktail. Retested and got 87 mg/dL. Whew!

 

That's much better!! (I'd just average the 2 tests....LOL)

Give it 30 minutes and test again and I'll watch for you again

 

97! Do you think we're ok now? Is it safe to go to bed? What's standard protocol for a situation like this? She's still eating.

 

I'd set an alarm and lay on the couch or something (instead of going to bed where it's too easy to fall sound asleep) and get 1 more test in about an hour

If she's still fine then, call it a night!

We like to keep testing for 2 "30 minute" sessions and then one more 60 minutes later for a total of 2 hours past the "low"...as long as they continue to come up

If they go back down again, that "2 hour clock" starts over

Welcome to your PJ party!!

 

Sounds like a plan! Thanks for walking me through this! Callao sends a grateful slow blink your way!

 

I'd also like to invite you over to the Lantus/Levemir Forum

Everyone there uses either Lantus or Levemir and it's a very active forum. You'll get lots of experienced eyes watching out for you there!

Every day we start a new post with the date, cats name and AMPS number.....then as the day goes on, you "edit" the subject line and add new test results

In the body of the post you put the link to the prior days post and then report on how Callao is doing otherwise...eating OK? How about the 5 "P's"? (Peeing/pooping/purring/playing/preening?)

If you have a question, you'd ask it here too....and if your daily post contains a question, you can use the ? prefix in the subject line

Hope you'll join us there....it becomes very much like a family there and we really get to know each others kitties!

 

Wow, that was quite a drop. Did she have a burst of energy in there somewhere before the lowest reading? I know you said she was sleepy, but that was at the end of the roller coaster dip, right?

LOL, "the 5 Ps"

 

Thanks for the invite to the Lantus forum, Chris and China! I'll check it out in the future. I'm still trying to figure out how to navigate the message board as well as everything else involved in this whole diabetes thing.

Jeanne, she wasn't crazy energetic tonight. I think part of our issue is food right now. Since she has kidney disease, she's been mainly on a high carb diet for the past two years, with a small amount of low carb wet food. When she got the diabetes dx, her vet suggested keeping the same diet and just using insulin. The problem is that she grazes throughout the day on the dry high carb food, but some days she prefers nibbling on the wet and ignores the dry, which I think drops her blood sugar like crazy. We have an appointment with the vet tomorrow, and I'm going to advocate for a diet change. I found a high quality, kidney friendly, low carb wet food that I would like to feed her exclusively (rather than keeping up with any high carb dry food). I think I'm also going to suggest no insulin or very reduced insulin during the first days of the new diet so we can figure out what her real glucose baseline is when we're not pumping her full of carbs. Fingers crossed that all goes well!

 

It's pretty much the same as it is here in Health and if you look you'll see how most of our subject lines look....it's really not hard and we'll help you!...but of course you're free to continue posting here as long as you like!!

It's just there's so much experience there and the more experience you have watching out for Callao, the better!!

Your vet may fight you on the diet change....they don't really get any nutritional education (other than what they get from the prescription food salespeople) so most think there's something "special" in those diets. Here's a great article on The truth behind prescription foods for you to read.

Getting the high carb dry out of her diet may be all she needs to be able to go into remission! Look at Coral's spreadsheet ...She fully transitioned to low carb only on 9/2/15.....Her OTJ party was on 10/3/15 (Off The Juice) She's one of the best success stories for a low carb diet we have

 

Well folks, her +4.5 reading is at 148 mg/dL, two hours after her low. She came out from hiding under the bed to cuddle on my lap... must be feeling better! We're going to call it a night. Thanks to Chris and China and Jeanne for your support tonight!

 

Good night!! You did GREAT!!!

She may very well bounce high by AMPS (especially with that nose dive she took!!) but that 59 means to reduce tomorrow....if she's really high (like above 300) and you can test (since we saw what she did tonight) you could consider giving one more 1U dose (we call it "shooting through the bounce) but then you'd definitely take the reduction at the next shot time

Have a good sleep!!

 

Thanks! If her BG is < 400 mg/dL in the morning, I will feel very uncomfortable giving her morning dose, since she dove from 357 mg/dL tonight. I have to work tomorrow so I can't be home to monitor her as closely (my fiance will get to practice his pet sitting skills, but he doesn't do needles or poking... yet). She has a vet appointment at the time of her evening dose tomorrow, so I will get to discuss things with her vet before giving her evening dose.

As soon as she came out to cuddle, my heart melted and I knew it was totally worth it to stay up with her as long as it took. They say interspecies relationships can induce a release of oxytocin just like human-human relationships. I'm pretty sure that by that standard and any other, I am absolutely in love with this critter.

 

Of course we and our cats imprint on each other! It's True Love. I have no problem admitting that I view my furkids as my babies. We sweat bullets when they're sick, and take joy in watching them leap around when they're feeling well.