Dweezil's confusing readings

Hi all! I was first here back in 2014 when Dweezil was first diagnosed at age 6.

I dropped off the radar for a while as we were never able to get successful blood tests at home.

Recently, we were away for a few weeks overseas and Dweezil developed Ketoacidosis. It was terrifying but he pulled through and bounced back quickly.

He was then fitted with a stick on constant glucose monitoring sensor which has been AMAZING and has saved his life several times.

Over the last few weeks, he went from 2 units to 2.5 to 3 units at the cattery due to his consistently high numbers and the fear of another keto incident. Mostly, these doses seemed to not do much but then every 4-5 days, the dose would suddenly work too well, and he would go way too low for over 8 hours and was not able to have his next shot, which of course then caused him to go too high again.

Anyway, since he's been back home, these are his readings. I'm sorry I don't have a proper spreadsheet at the moment. The one in my signature is hugely out of date and lacking in data.

His cattery dose has been 3 units. His previous regular dose at home was around 1.8 units.

All blood glucose readings are in mmol as I'm in Australia. I hope that's ok.

Friday AM preshot 5.30am - 25 glucose
(3 units given by cattery)
+ 4 hours - 12 glucose
+ 7 hours - 16
+ 8 hours - 15
+ 10 hours - 13
+ 12 hours - 11 (nadir) waited another hour for him to get up to 14

Friday PM preshot 6.30pm - 14
(1.8 units given by me)
+ 2 hours - 15
+ 4 hours - 13
+ 6 hours - 14
+ 7 hours - 9 (nadir)
+ 10 hours - 15

Saturday AM preshot 5.30am - 16
(2 units given by my partner)
+ 2 hours - 21
+ 4 hours - 3.9 (yikes!)
+ 4.5 hours - 3.8
+ 5 hours - 2.2
At this point Dweezil seemed completely normal, not at all like the other times he's had hypos.

I gave him some of his normal wet food and he ate well. Still at 2.2 though. No food-spike at all.

+ 6 hours - 2.2. More food given, including slightly higher carb food. Dweezil still seemed completely normal.

He remained at 2.2 for the next 5 hours with no change. Seemed normal the whole time.

+ 11 hours - 5
+ 12 hours - 8
+ 13 hours - 9

I was not going to shoot at this number after he'd been so low all day so fed him and his brother their dinner as they were getting antsy, and then I went out to dinner.

Saturday PM preshot - 16 (partly from the dinner 2 hours earlier?)
(1.2 units given by me at 8.30pm)
+ 2 - 15
+ 3 - 16
+ 4 - 13
+ 4.5 - 11.3

I'm heading to bed now as it's almost 1am but Dweezil always sleeps with us on our pillows so when I wake up in the night, I will easily scan him. I will update more tomorrow after the rest of the night. I expect he is already close to his nadir by now and it may get down to about 9 again.

What baffles me is the huge sharp and extreme drop of today. And how he seemed perfectly fine.

Also how his previous cattery dose of 3 units mostly didn't get him below the mid 20s and yet at other times, brought him down to 3.3 for many hours. And now at home, 3 units would clearly be way too much.

Anyway...any insights or similar experiences would be SO appreciated!

Dweezil was diagnosed in December 2014, has always been on Lantus / Glargine, has been tested many times and has no other underlying health problems. He is 8.5 years old now.

He weighs right now 11.5lbs which is up from 10.8lbs he was a few months ago. Before diagnosis and whenever he is regulated for more than a few months, his weight naturally reverts to 12.5lbs.

Thank you so much!

 

Hello, Dweezil's mum! Love your picture of Dweezil and Monty. So glad for you that Dweezil bounced back quickly after the DKA. The stick on constant glucose monitor sounds amazing. I want one!

I don't understand your numbers at all, but I'm sure someone with more experience will. I'm sure they'll be able to help you. In the meantime welcome back!

 

DKA is incredibly scary. Many of the kitties here are survivors so we know how lucky you and Dweezil are.

If I may ask a favor... The best way for us to offer assistance is if you set up a spreadsheet. There is an international version that will automatically convert your readings into the US numbers. Most of us are from the US so it would mean converting every number from mmol/L to mg/dL, the latter being what most of us use. In addition, the spreadsheet is color coded which allows everyone to better see trends in Dweezil's numbers. This is the link to the spreadsheet information. Remember to use the World Template and not the US template.

One word of caution -- 2.2 mmol/L is too low. It's around 39 or 40 in US numbers (multiply mmo/L by 18 to get US numbers). You need to give Dweezil high carb food when numbers are that low. It looks like you did feed your kitty but you may have needed to be more aggressive with the high carb food. You also need to test every 15 - 20 min to see if the food is bringing the numbers up and if not, give more HC food or add something like corn syrup to your kitty's food to bump up the numbers.

The drop from +2 to +4.5 is not that big (270 to 203). However, without a spreadsheet, there's no way to know where Dweezil's nadir falls. (This is the other big advantage of a spreadsheet -- you can see when Lantus onset and nadir fall as well as how much duration you're getting.)

 

Me too! Can you tell us more about it?

I can't offer any advise either as I am not sure how the numbers convert to US measurements. Any chance you can put them in the spreadsheet? It will (should) convert them to US measurements on the US tab when you enter them on the world tab.

What food is being fed? Do you know what % carb it is?

 

I agree. Would love more information about the constant monitoring. I asked if there was anything like that for cats was was told no.

Please share information about the device.

Welcome to the board. I'm not experienced enough to give advice on insulin.

Love the photo of your cats together

 

Welcome back!

There are a couple of main factors for why his numbers might be high most of the time, but drop every 4-5 days:

1. Lantus is a depot insulin, which basically means that it has a cumulative effect. You can read up on the insulin depot in this sticky: What is the Insulin Depot? Most cats seem to respond to a new dose, or recover from a missed shot, after about 3 days, but 4-5 days might be your cat's pattern. As you start to collect more data, you should be able to pick out the trend.
2. It is also a normal physiological response for a cat to "bounce" to high numbers after hitting a lower number than they are used to. The body perceives a threat and releases extra counterregulatory hormones to combat the low numbers. Those hormones can take a few days to clear out.

The depot works both ways - it takes a few days for the insulin to begin performing at its full potential, but it also takes a few days for a dose reduction to fully take effect because there is still some excess insulin in the system for while. That means that the low numbers on Saturday might not have come just from the 2 unit dose that was given that morning. It was partly from the 2 unit dose, but there still was probably some effect from the 3 unit dose that was given up through Friday morning.

Since you are just getting back into the swing of things, you may be almost starting over data-wise (I don't mean starting over with the dose, just with collecting data so we can see what is going on).

If I were you, I would make the following my priorities for the next several days:

• Don't give 3 units. If it was taking him too low every 4-5 days, and since you saw a prolonged low number a day after giving that dose, it is probably too much for him now.
• Pick a dose to give, and try to stay with the same dose for at least 3-4 days. Test whenever you are able between shots to start getting some data again. Obviously if he goes too low during the 3-4 days, then you will have to reduce the dose again, but try not to worry too much about high numbers. I wouldn't be too surprised if he does go high for a couple of days, so try to be patient and wait it out.
• Start keeping his spreadsheet again. If you are able to fill in a week or two worth of back data too, that would be helpful, but at least start with the information you posted in this thread.
• Since he has recently suffered from ketoacidosis and you are reducing his dose, test for ketones at least daily.

Those are just some of my thoughts. Questions? And I agree that a scanner sounds cool!

 

Hello again and welcome back. I am glad you have a system for getting blood tests now. Good thing you were able to catch those low numbers. Does Dweezil have the Freestyle Libre attached? Another one of our Australian members, @Girlie's mom had it attached to her cats shoulder for a while.

 

Thank you all for your support!

I've updated the spreadsheet in my signature, but I can't get the numbers to change from mmol to mg and they're all showing as green, even though some are high and some are low!

Dweezil pulled his monitor off last night at 1am. So now I feel like I'm blind! Hoping to get a new one put on tomorrow.

It sticks onto the skin with strong adhesive. It's brand is Freestyle Libre and each sensor lasts for roughly 2 weeks. You get a reader and you hold it to the sensor for 1-2 seconds and it gives you the number for that second in time. It also automatically records the glucose every 10 seconds I think and shows you a graph of the days so you can see the patterns.

You can also hook up the reader to a PC or laptop and generate reports and save them and email them and such.

I WISH they could make it so the sensor was under the skin like a microchip, instead of being stuck to the shaved skin and thus causing irritation and the risk of removal. I wish it could be permanent.

 

At least it's some progress in the right direction. I am guessing they are expensive? The microchip under the skin would be great. Maybe one day it will be made. I remember way back in 2005 when J.D. had his DKA hospitalization at a veterinary college, they had a backpack type thing strapped to him and it was a constant monitoring device. It was cumbersome and big resting on his shoulder area.
I'm sure someone will be along to help you figure out your spreadsheet. It really is needed for us to help you help Dweezil. Are you entering the numbers on the world spreadsheet?
Keep testing for ketones daily at least, for awhile.

 

Thank you!

Just heard we're definitely getting a new monitor put on tomorrow, HUGE HUGE YAY!

I must try and redo this spreadsheet I think. I did something to it. I am slightly technically challenged at times. Lol.

I also don't think 2.2 is at all safe, and I gave him first some of his normal low carb food (can of Whiskas loaf) and then a bit later some more (Cats in the Kitchen) with a sachet of Whiskas (which is higher carb than the cans) and some tuna loin he loves, and also some dry food (the Royal Canin diabetic one). None of this changed the 2.2 reading and then the machine stopped working.

Dweezil seemed perfectly fine. Nothing at all like the other times he's gone hypo and has been restless, twitchy, glassy eyed, less responsive to stimuli and just not "right".

I've heard the Freestyle Libre can give lower readings than what is actually accurate. Especially when an error then occurs. I think this may have been the case, BUT he was still too low nonetheless.

I also agree that his prolonged low numbers then were also coming from the previous 3 unit doses he had been having.

Oh, and yep, we test for ketones at least once daily. Whenever we catch him peeing we use the Keto-Diastix for both glucose and ketones. We personally have never seen even a tiny trace.

I think obviously 3 units is too high for him. I think 2 units or just under might be his sweet spot.

Today and tonight he has only had 1.2 units as we don't know his numbers. Too low a dose, probably, but we need to keep him safe.

I am really looking forward to getting the new monitor on so we can really adapt his dosings to his needs.

Oh, and I think each new sensor is $250-$300 and the monitor / reader is about $150 (Aus dollars). We have pet insurance thank GOD! Lol.

 

I don't see new (2017) info on the SS. It might be easier to set up a new one.

Here is the link with the instructions

FDMB SPREADSHEET INSTRUCTIONS

If you have any problems, post up for help and one of the experts can assist.

 

At the bottom of your spreadsheet, there is tabs for world and US. Remove the numbers from the US tab and enter them with the dates on the world tab. It should automatically put them on the US tab. That is why all the numbers are bright green, because for US, all those would be extremely high.

 

Ok, I THINK it's working now! There is much other data from all of July at the cattery but it's much the same as the first few days I've recorded here while still at the cattery.

I just realised it hasn't transferred the numbers to the US tab except for today! Grrrr!

 

I am glad you got the monitor back and were able to catch that 36 (2.0). Since it's so close to PMPS time and he's so low, you might have to just skip tonight to drain the depot. But I'd feed him a little higher carb food to bring him up above 50. And maybe try 1.0 units as his new dose.

 

Yes, I don't really want to keep delaying his PM dose (and thus all doses) by hours as he really should be in some sort of routine.

I've added to his spreadsheet again. He's coming up nicely now. Not dinner time yet.

He ate 3 small meals during today's low time and it did nothing in terms of his numbers, even the higher carb food.

 

I've added more data for the last 2 days. Dweezy just for some reason seems to go very low each day even on low doses. At night I am ultra cautious so he doesn't go low and has a very flat curve a little higher than ideal, but during the day he is plummeting straight down.

We used to think his nadir was 4 hours as when he would show symptoms of going low it would always onset at exactly 4 hours. But now it seems his nadir starts around 5 hours and then just stays at that same low level for a long time before slowly rising around 12-15 hours after the last dose.

 

Part of the problem might be due to frequent dose changes over the last week. That can mess with the insulin depot and cause erratic numbers ranging from too low to much higher. I like the idea of a 1 unit dose (as Wendy suggested) twice a day for a week or so to see if he'll settle.

 

Yes, that would be ideal, BUT he is still going way too low even on 0.8 of a unit! I can't leave the house each day! He seems fine but even high carb food doesn't raise the numbers. He just seems to drop at 5 hours, stay there until he's ready to rise on his own and then slowly go up about 6 hours later. Then he has his dinner with no insulin and goes up briefly but then goes down again by himself so I still can't give him his insulin!

 

I have a question - he was very high a lot of the time in the cattery and had the DKA earlier on (a month ago) during that time. Is him being so frequently low nowadays good for his body? As long as he's safe of course. Is it giving his pancreas etc a rest from the strain of those previous high numbers?

 

The simple answer is yes.....keeping him between 50-120 (2.8-6.7) as much as possible gives his pancreas time to heal

I agree with the others too....I think you need to give the same amount both AM and PM...Lantus craves consistency so it works best when given at the same dose

I think what's happened the last few days anyway is that he's gone low and then "bounced" high. Bounces are caused by the liver releasing stored sugars and hormones to bring the blood glucose back up to a safe number or a number the body has gotten used to being at. Bounces can be kicked off by 1. dropping too low, 2. dropping too quickly and 3. dropping into numbers the cat's body isn't used to being at.

They can take up to 3 days to clear, so it's important not to increase the dose until you know the bounce is over.

Lantus dosing is always based on how LOW it takes them, not how high the Pre-shot numbers are

Did you give .8 this morning? There's no entry in your spreadsheet in the AM "U" cell

 

Oops, sorry! Yes, he did get 0.8 units this morning. Actually, I had a look and there was the 0.8 there in the AM U column. Maybe it didn't save properly.

We're going to try 0.8 units tonight and 0.5 tomorrow and see how he goes. I think there MAY be a slight discrepancy with the injecting technique that is resulting in the more extreme absorption during the day. My partner does the AM shots and I do the PM.

Last night I gave 0.5 units and although safe, his numbers were a bit high. Today on 0.8 units given by my partner he went too low and stayed there too long again.

Tonight 0.8 units might be better and in the morning 0.5 to see if he still goes down so far.

I know we should be giving the same dose both times, but 0.5 isn't enough at night and 0.8 is too much in the day.

We are actually reducing his dose down and down, definitely not increasing it.

Before the cattery, he was on 1.8 units and this seemed to work for him. Of course, we didn't know that much then apart from good random blood test results, "excellent control" fructosamines, gradual good weight gain, no ketones, low urine glucose Diastix results, good water consumption, good appetite and normal Dweezil behaviour.

At the cattery, on 2 units after a week resulted in DKA. Once he was stabilised, it was established that 2 units was a good dose for him. He was hugely stressed at the vet but on 2 units still was well controlled except for going down to a BG of 3 a few times.

Back at the cattery, 2 units was effective for the first 2 days before suddenly not working anymore. Up to 3 units. This would work sometimes and he would go too low and then other times it would seem to have no effect.

Once he got home, his insulin needs seem to have hugely decreased. If he's going so low on just 0.8 units when he was on 1.8 - 2 units before...

 

With all the changes in his dose, he's going to have wonky numbers....the depot isn't getting a chance to settle down and show you what it's really doing.

I'd try giving .5 both AM and PM for the next 3 days (unless he drops too low again) and let's just see how he does

 

Really? 0.5 both AM and PM? Are his night time numbers ok? Not too high?

 

Well, I tried for a dose somewhere between .5 and .8 and now at +2 hours, Dweezil is at 18, up from 16 at the pre-shot time. Hmm.

 

More than likely a bounce from the low greens. Stay the course with a consistent dose (AM & PM) and see if he will flatten out.

Do you have scheduled feedings for both AM and PM cycle?

ETA - this may be of interest to you

• Using Food to Manipulate the Curve

 

Ah yes! I have been doing this sort of thing for years but didn't realise it was a thing!

In the past, at night I would feed Dwee up with a big dinner of lc food at his shot time and then he'd eat the rest about an hour later. Then 2 hours later he'd have his supper of more lc food. Then at bed time 3 hours later he'd have a night cap.

I was trying to kind of pad him with food to avoid any crashes.

In the mornings, he has his breakfast with his shot, then has some more about an hour later, and then we nap together in bed and he will have another bit of food (all lc) about 3 hours later.

Only if I feel (or know, like lately) he's going low, will he eat another meal between lunch and dinner.

 

Up to over 20 now at +5. Sigh.

 

What a beautiful cat, loving the SS, you can really tell where onset and nadir is with it completely filled. wow
I am in Canada so looked at the global numbers it does look like you may need to just download a new SS template, and simply copy and past the values on the Global Tab. Just Make sure not to touch the US one (remember my first time I wasn't paying attention and entered my data in the wrong tab)

Hope Dweezil is doing better.

 

Thank you!

Frustratingly, Dweezil has now stopped responding to these low insulin doses that just yesterday pushed him so low for so long.

 

36 yesterday was pretty low, that's why he's bouncing so high. Have patience and hold the dose. We find it's best to give the same dose in the AM and the PM. Due to the nature of the insulin depot, what you shoot in one cycle is often heavily influenced by what you shot the cycle before. Which means shooting a higher amount like you did this morning may influence more of tonight's cycle than today. If you are going with 1.0 units as the new dose, stick with it for at least 6 cycles (unless he goes low) for the depot to stabilize and tell you what the 1.0 unit is doing.

 

What's hard is that he has until last night been going too low daily so we couldn't maintain a dose.

 

Do you feed him LC, or MC, or HC when he has low numbers (are you home? machine maybe confusing us) to increase the BG? There are certain things you can do to manage low numbers when you are around, and tricks to determine if there is a potential for low numbers when you are not. The more experiences people here can help with that.

With Lantus you don't want to delay the dose, you may need to skip it or give a reduced dose depending on the number and which method you are using. You really want to keep as close to 12 hrs cycle as possible. You can adjust upto 30 minutes per day (I messed that up a lot at the beginning). The depo is sensitive.

It does look like the 3u was way too much for Dweezil. Glad he is at a lower dose, you should now be able to tell what is happening better, with the SS. Really impressed with the machine for BG, like you said would be nice if it was a microchip under the skin.

 

I feed him his normal lc at first with low numbers. If they don't budge after 30 minutes, I feed mc food. He always seems fine though hungry and loves the mc food. Lol. Special treat for him.

I am home a lot. No set 9-5 job. Lucky for both of us!

 

I fear when the device has to come off. They're only meant to be worn a maximum of 2 weeks and not constantly being replaced.

Now his reading just says HI. So I don't know what it is. Above 25 I think.

I was just looking at his daily graphs and it seems like he only goes into the target range on his way skyrocketing up or on his way plummeting down. He never actually hangs out in a good range.

 

Back to low numbers today. Dweezy seems fine and has been fed small meals regularly.

I was reading a bit about the tight regulation protocol and it mentions what rules to follow in terms of increasing, reducing and holding the dose.

It mentions holding a new dose for 5-7 days if there are low nadir numbers. This makes me nervous as I don't want to give the same dose twice a day to an already hypo cat.

It mentions increasing the dose earlier than 5-7 days if the nadir is high. This is what happened previously with Dweezil when his nadirs were the same as all the other high numbers during the 24 hour period. They were worried he would get DKA again if left too high for too long.

So...how do you know what to do when your cat is regularly low AND high? Risk them going even more hypo or risk them getting DKA while you wait to see which dose works?

Over the years, we have established that after 2 weeks, 1 unit is too little. That 3 units is too much. 2 units has been both good and not good. And somewhere between 1.5 and 2 has been good. Except when the environment changes like a cattery, visitors or the vet. And AM and PM can give totally different results.

Help! Lol

 

You only hold the dose if they do not earn a reduction. Dweezil earned a 0.25 unit reduction today. I would try 1.5 units as the next dose. The high numbers are just a bounce from going too low.

A cat's insulin needs can also change over time. What worked even a month ago may no longer be a good dose. And many cats do go lower at night. Though it looks like Dweezil os not one of those.

 

My partner sometimes jokes around that Dweezil is being difficult with his ups and downs. I don't like that. He can't help his body. It's up to US to work out how best to help him.

I actually asked her to give 1.5 units tomorrow morning (he has his dose at around 5.45am with his breakfast) so HOPEFULLY it might soften these sharp drops during the day. I gave 1.5 units tonight at 5.30pm.

 

So 1.5 units today resulted in a gentler curve but a higher and earlier rise prior to the PM shot.

 

Hmm. 1.5 units has now resulted in too high numbers again. Sigh.

 

This was only the 2nd cycle at 1.5......you have to give the depot a chance to stabilize

Around here, we talk a lot about putting on your patience pants......Here's a pair for you!!

 

Lol!!! I know, I know! Thank you for making me laugh! Those pants are delightful!

 

If you like, I could go into the spreadsheet and fix those first few days so that they convert correctly. You would need to give me access.

 

Yes please! How do I give you access?

Those first few days are over a week ago now so less relevant, but I'd still ideally like it all to be right.

 

I just sent you an access request. It should go to the email linked to that Google Drive account.

 

Thank you! I think I accepted it and gave you access. I'm a bit technically challenged. Lol

 

It should be displaying correctly now.

 

Thanks so much Heather! I can see the US SS now works, but now my worldwide one isn't working! I'm entering my numbers in for this morning and it's giving me greens even though they should (sadly) be reds and pinks!

 

Spreadsheets are fickle. Now is it showing up correctly?

Also, please don't hesitate to message me in the future if something else is acting wonky. Dagron's diabetes has me stumped, but I do know spreadsheets.

 

Thank you so, so much!