+3 BG is 47. Time for gravy?

I am concerned. I am curving Sarge with 2 units of Novolin 2 (the lowest dose he as had to date) and he is at 47 at hour 3. I am afraid he has at least an hour until nadir. Is it time to start giving gravy to head off a problem? He is eating and acting fine. He now has a spreadsheet in my signature. Easy peasy thanks to the good instructions

 

I have no experience with Novolin (Hannah is on Vetsulin), but we had a near hypo last week and I followed the hypo protocol anyway, just to be safe. But she was only 134 at +3 and hit a low of 59 at +5 after high carb food being given starting at +4. A BG of 47 at +3...I would definitely bring on the gravy and have the syrup nearby! Did you test BG twice to be sure?? If you can get another BG in quickly, maybe check that before you start with high carbs, but otherwise, I'd start in ASAP and test every 15 minutes until he's through the expected nadir. I'm still new to this, but it sounds like cats will always recover from a temporary hyper, but a hypo can kill in a very short amount of time.

 

Here is a link to the hypo reference guide:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

Here's another good post on low readings:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=61799

Is he showing any symptoms other than the reading?? (My Hannah didn't and I treated her anyway, but just with high carb food. We didn't ever need to pull out the syrup.)

 

This part seems particularly applicable from the 2nd link in my last post:

=========================================================================

If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of food with high carb (HC) gravy or HC food only. (If you have a cat with GI issues, using syrup plus LC food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.

DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

=========================================================================

 

Thanks so much! That was what I was thinking too after reviewing the hypo page again. So I retested while waiting for replies and he was at 40. Before I could even retest him he was in the bowl of FF eating. I let him eat and then tested. So about 15 minutes had elapsed before I got the second reading. He is now eating two tablespoons of gravy lover's FF. Will test again in 15 minutes and have the honey handy. Thanks! I am so not a fan of this kind of insulin. Glad to hear Hannah did well last week!

 

I checked the online user list and there was someone who has been dealing with a diabetic cat for 6mo and may have more experience than me. I private messaged that person about your 911 to see if s/he could help as well. Hannah was only recently diagnosed (two weeks before Sarge) so I'm trying to get someone with more experience to assist.

 

Shoot - my private message didn't send. It's stuck in my Outbox and it seems the only reason is that there must be a problem with my profile that needs to be fixed by an administrator. There are now 5 other users on now, though. It was just the two of us when I first saw your 911. I'm hoping someone else sees it and responds.

How is Sarge doing?

 

Wow, thanks Jennifer. Even in your short experience you told me just what more seasoned veterans did moments later. Thanks so much to all of you.

Just retested. It's been another 15 minutes and most of a can of FF Gravy Lover's and we are up to 59. Headed in the right direction. I will keep on it to make sure it stays that way.

I am scared to ever give him 2 units again. What worked just a few days ago seems like too much now. I can't be home tomorrow to test during the day so I am tempted to just give one unit tonight and see what happens as a trial for tomorrow. I can tell Novolin drops him too low too fast but I am also curious if he is starting to supplement his own insulin too. All of a sudden it seems tricky to go slow with changes AND keep him in safe numbers.

 

Hi - my name is Cindi. Looks like you got all the good information and are following the procedures. I would continue to give a little bit of higher carb food. Don't give a lot - maybe just a couple tsp. because you don't want Sarge to get full and not want to eat when you still need to get some food into him. Sometimes just a tsp is enough between tests.

When is the last time that you tested? I would test about every 20 minutes until you get three in a row of upward swing. If he dips below 40, I would give him a little bit of honey and water and drip it over his food. The honey or syrup should swing him up pretty quickly but does not last long so that is why you need to keep testing.

How are things going now?

 

That's almost exactly what happened to Hannah. 1.25u of Vetsulin seemed to be keeping her in highs of 350+ and lows of only 150s, so I upped it to 1.5u and it was fine for the first few doses, but then on about the 3rd dose she dropped from a starting BG of 408 to 134 by +3, and I knew her nadir was usually around +4.5 or +5. After that, I dropped back to 1u for this week and will attempt 1.25u again for the first time tonight...so I know exactly what you've just been through. I'm glad I could help!

 

Hi, How is Sarge doing now?
And how long since his shot?
Edited to ask: Which glucose meter are you using? Alphatrak or 'human' meter?

And yes, Jennifer has given you some very good advice (and it's good to see an advice-giver who takes the risk of hypo seriously! Sometimes folks can get a wee bit complacent...).

Eliz

 

Just tested again. These tests coincided pretty close in time with his +4. The first reading I am almost sure was a bad sample, 54. Retested twice and got 80 & 87. So, I think the higher carb food is working and we are back into the 80's. I will bug him again in 20 minutes. I will probably have to call him down again from his sleeping place behind the Predicta tv's by then. Such a good kitty. He actually comes when called for this. Fingers crossed it stays that way!

P.S. Using a ReliOn Confirm.

 

Nice job! Sure is nerve racking isn't it but you did an awesome job of getting Sarge back in a safe place. Great job also in catching it and posting. When I see Merlin getting a low number early on, I start with giving him low carb food and then test him shortly after. If he continues to go lower, I either give him medium carb food (say 10-12 carbs) and then test. I either continue with the medium carb food or if that doesn't work, I go to high carb food (15+). Then if all that fails, then I get the honey and water out and that usually does the trick. This all depends on what the number is and when I catch it. I can tell you the first couple times he got low, I would get so nervous. I was so anxious between tests and feeding. Then after a few times, I didn't get so nervous and I just dealt with it. Anyway, great job in catching the low number and turning it around.

 

Another 20 minutes have elapsed and I tested him again, now 100. I will offer him some regular FF in a little bit to keep him up but no more gravy. Don't want to get too high. After two nice readings I think Sarge and I (Alison by the way) are out of the woods, though I will keep on him. I can't thank you all enough for walking me through my first experience with low numbers. It is so much easier to stay calm and deal with things when you know you have back up

 

You did great! You probably saved Sarge's life today! (47 is a scary +3 number.) You should be very proud!

Another post just reminded me that Hannah's pre-shot BG number before her next dose after the near hypo was really high (518). She also was back to drinking water and peeing like crazy. But only for that day. Her pre-shot BG was back to normal the next shot after the 518 and the water drinking stopped a few hours later. So be prepared for a weird high reading at your next dose, and maybe some of the old pre-diagnosis symptoms. It's fine. They go away. Look up Somogyi effect to find out why the BG bounces so high and the water drinking reoccurs after a hypo.

After Hannah's event, I was advised by several members of this forum to also drop the dose back to 1u from the 1.5u that had caused the drop. I looked at Sarge's spreadsheet and it seems like he's been on a higher dose since you started, so it's possible his pancreas is starting to work on its own again and produce some of the insulin he needs, which compounded with the insulin you gave him, was too much. You may want to post again with a different subject line, asking for Novolin advice. Everything I've read so far says to start low and work your way up, but without more experience, I wouldn't want to advise you on where to start.

 

While I was reading this thread with Sarge purring next to me my phone rang. It was the vet's office. After being told earlier in the week to not treat with sugar until the cat is laid out, I gave up on calling them when Sarge was getting low and formulated my own plan. I studied the hypo action sheets and hoped I wouldn't need them. A sliding scale of action just makes so much more sense than treating the crash. So, fighting a little resentment I just filled them in on the morning's festivities. At +5 we are at 148. Good to know gravy packs a little punch. Better to be on the way up! I am supposed to call with his later numbers. Curious what she says to do. I would have to say a dosage reduction is in order. A BG of 40 before nadir kind of speaks for itself.

Thanks for the pat on the back guys for the hypo catch. I am so humbled that I was home all day to track what I thought was going to be easy dosage for him. I shudder to think how bad this could have been if I hadn't found the resources for testing/tracking and carefully adjusting dosage from day one. This is the closest I have ever come to knowing what it feels like to be the mom of a sick kid. Thanks too to Jennifer for the heads up on Sarge's next PS number. I was wondering if there might be some temporary wonkiness I would have to ignore until he had a chance to "sort" himself. Purrs.

 

Oh I know exactly what you are talking about. I don't know what I would do without this site. I would be forever hounding the vet or worse yet ... giving up because of not knowing what to do. I can't begin to think how many little kitties have been saved by their owner finding this site. I have learned so much and it is amazing how much control we do have over our little fur babies. Just like you said, a little bit of gravy goes a long way. It is amazing how much you can control and turn things around with a little bit of knowledge. I am constantly thanking the stars that I have found this site and the amazing people here that are willing to help out.

Regarding vets, it has taken a little bit of time for my vet to feel comfortable with me. I think it is new to the vet for patient owners to take on such an active role. The vets and vet techs told me that they have never had their patient's owners get so involved i.e. home testing, seeking knowledge, reporting etc. I have been working with two vets in the same office and at first, they both just wanted me to give a consistent dose and no need to test other than 1-2 times per month. I couldn't understand why they didn't want me to test throughout the day. We are trying to get Merlin ready for a dental so I have been working with their suggestions for the past 3-4 weeks. Only for one week did I not test during the day (drove me crazy), otherwise, I kept testing and sending them weekly spreadsheets. Now, I am working with just one and we seem to be working good together. He likes the spreadsheet and doesn't say anything about my testing now. He is open to some of my suggestions and I am willing to try out his suggestions too.

So good luck with your vet...I bet it is new to them too.

 

I am sure you are right. I am almost positive I am their first/only home testing client so they are learning too. I just couldn't fathom giving insulin without knowing where we were at that moment. So, I started researching how to do it. My vet was open to the idea which made me very happy and I think they appreciate the extra data too. All three of my cats love this office. When Sarge dislocated his tail and my vet fixed it he rubbed on her and purred. That is big. I don't care how good of a vet you are. If my well behaved cats hate you, not gonna happen. This is also not the first time I have had to educate myself on a specific issue and we worked together to get one my cats through a rough patch. Lobster came out of two with flying colors, no prescription diet and off the meds for two years now. Knock on wood. Admittedly, it is probably a little frustrating for a vet, with many more pets to look after than I do, to have a client refuse the prescription diet and the usual way of doing things. After all the client is not the one who went to vet school. So, I always do my best to remain firm but respectful. I don't know everything either. Far from it!

 

Double post. Sorry.

 

Wow. Just called in my last two numbers as instructed. The tech on the phone said that the "wonky numbers" (her words) I saw at 3hrs were probably due to me using a human meter and not an Alpha Track with it's special "cat software." Totally ignoring the fact the lows were reproducible and part of an 8 hour glucose curve. Really? I respectfully explained why this meter business was a farce, that vets and scores of diabetic cat owners use this meter successfully and the "conversion guidelines" from human to pet meter. I.e. the Alpha Track reads higher, so my 50 is your 80. I didn't even get to explain why the so called human vs. Alpha Track study was inherently flawed (wouldn't pass the sniff test by my lab's standards that for sure) before the subject was dropped. Not because the tech agreed, but because there really wasn't a future in it.

They said since he ate when I found he was low he is showing he knows what to do when his sugar gets low and I shouldn't worry and to keep the dose the same. A tad scary when he would be on 4 units twice a day if I had followed his last discharge instructions!! The tech also asked me what made me do a curve at home. Really? Has everything we covered last visit been forgotten. Has the constant downward trend in his numbers I have been calling about been forgotten. Not everything can be blamed on being a "new diabetic" and so we should stay the course. One step forward, two steps back today I am afraid. Tomorrow is another day But...boy do I wish vet supply reps weren't so good at their jobs.