Beginning Hypo?!

Reposted. Hi guys - Lola’s bG has dropped to 4.4 mmol/L (80 mg/dL) at 10:00 PM after receiving 1 unit ProZinc insulin at 7:45 PM. Her PMPS was 9.2 mmol/L (165 mg/dL), and I was advised in another post to proceed with insulin.

I’m really worried it’s going to drop further. She wouldn’t eat the high carb food I have, so I’m giving her an extra wet food portion which she’s eating now. Hoping that brings her sugar back up. How worried should I be? Not sure what to do

 

You did the right think giving her a snack of her regular wet food. You have a way to go before nadir. Test again in a half hour and if she’s level or lower give another snack, rinse and repeat. If you can’t stay up to monitor you can abort the cycle by carbing her up - add honey, maple syrup, etc. to some wet food or feed some gravy style food if you have some in your hypo kit. You might need to drop the dose to 0.75 u tomorrow AM.

 

Okay; one thing she will always eat in past prior to diagnosis is McDonald’s ice cream. If her numbers stay low, would it be a good idea to give her some of that?

 

You could try that as long as it doesn’t upset her tummy. You might have to give small amounts of carbs often if you’re going to “steer” BG for a while.

 

That makes sense. The ice cream doesn’t upset her tummy at all. I will retest at 11:00 PM (20 mins from now) and see where we are at. How low would bG have to get before I should take her to the emergency vet?

 

As long as you have syrup/honey/karo at home, it's unlikely you will need an emergency vet. You might not get much sleep tonight, but we'll be here to guide you through if she continues to drop. I wouldn't carb her up too much at this point. Let's see if the regular food is enough to get her to surf along until nadir. Oh, and 2.7 is when you'll need to start thinking about carbs, but even that depends on when it happens in the cycle.

 

Don't feed her too too much right now. You want to keep her willing to eat if needed as the evening goes on. If she fills up now it could get harder later on.

 

It's cracking me up to imagine her eating an ice cream cone!

 

Okay, her bG = 4.2 mmol/L (75 mg/dL) now (10:54 PM). Should I try giving her a little more wet food?

Yeah, she’s very cute. She likes being fed ice cream with one of those plastic McDonald’s spoons. It’s adorable

 

So it was an hour between the 4.4 and the 4.2? Can you leave food out for her tonight to graze, or will she gobble it all?

 

You can give her some more regular food, and then either leave out some food for her if that's an option, or set an alarm to get another test in an hour or so.

 

Yes, that’s right. I could leave it out, but chances are my other cats might steal it... worth trying though. I’ll put it by her favourite lounging spot.

I’ll set an alarm and get another test in an hour

 

If she still around the same range at your +5, you should be fine for the night. I’m usually the last one awake here in Prozinc-land since I’m on the west coast, and I’m going to bed in just a second. If she’s low at your next test, post out in the Main Forum and someone is usually around out there that can help.

 

Okay, thanks for your advice. She’s at bG = 4.3 mmol/L right now (12:40 AM). I’ll grab one more spot check at 1:30 AM.

 

Oh dang! I didn't see that coming at all. I really thought she was going to surf as it looks like she has been. Definitely looks like time for a dose decrease.

 

Just retested this morning, and it was 7.8 mmol/L (140 mg/dL). I’m assuming I should skip the 1 unit of ProZinc insulin I’d normally give her now?

Don’t worry about it, Rachel - these things happen! The important thing is we caught it, so all is well. Yeah, a dose decrease makes sense to me.

 

Are you going to be home to monitor?
I wouldn't give 1 unit. Definitely decrease to at least 0.75u or 0.5u... see what the others think.
Hopefully they can check in before shot time. I know the site gets bogged down around this time in the morning.

 

Unfortunately not; I’m a biochem grad student, and I have some time-sensitive experiments I can’t put off... would there be any harm in skipping the insulin to be safe?

 

Okay guys, I’m going to default to not giving her insulin this morning... I’m figuring I’ve skipped doses before (back when she was first diagnosed and I was nervous about numbers) and seen no clinical repercussions. I’ll retest her tonight when I’m back from work at her regular PMPS @ 7:15 PM. For what it’s worth, she seems very bright and happy this morning, so that’s good at least

 

It's best to be safe than sorry.
Sorry I couldn't respond right away.

 

Sometimes skipping is the safest thing to do.

 

It definitely won’t kill her to skip. You gotta be safe! So sorry we weren’t here...I was on the way to work.

What time zone are you in? Helps us have a better idea when to check in.

 

It sounds like you have long days, but if there is any way you can start getting some mid-cycle tests - if not a before-bed test every night, then at least committing to more testing over the weekends it would really help. It's entirely possible that the one unit dose last night was actually a good amount for her. But because we don't have other tests to go by, we had to treat it like it was potentially dangerous. If you look at my spreadsheet, my kitty quite often drops early in the cycle and then surfs safely through the nadir. Last night he was at 68 at +2 and I had no problem just going to sleep because I know his patterns.

Another possibility is that your kitty is going to start dropping in dose. That tends to happen fairly quickly and the extra tests will help you know when to reduce to keep Lola safe. You can see her PS numbers are coming down, and it's possible that she has been having some mild hypo numbers for a few days now. A healthy cat can compensate for that for a little while, but not for long, so making sure she isn't being over-dosed is important.

 

Okay guys, her blood sugar is now 9.9 mmol/L (178 mg/dL). She was fed a serving of wet food 20 mins ago. Considering she skipped insulin this morning, what dose should I be thinking about right now? Maybe 0.75 units? 0.5? Advice would be great; I’ll hold off for 20 mins in hopes that one of you sees this.

Yeah, really long days for me... I commute for 1.5-2 hours each way to the lab, and I’m there for 8 hours. I can get mid-cycle reads this weekend though. In the interim, I’ll continue with before bed testing in addition to AMPS/PMPS.

No worries! I’m in Eastern, and I generally do a 7:15/7:15 schedule.

 

I'd try 0.5 u because she stayed low even without insulin this AM. Get a +2 for sure. Exciting!

 

Alright, thanks so much! I’ll give 0.5 units now and post a +2 once I have it.

 

Okay, she’s had her 0.5 units and her +2 is 7.9 mmol/L (142 mg/dL). Would you guys say that’s pretty good? Probably should continue with 0.5 units assuming her pre-shot values stay consistent?

 

Let's see where she's at in the morning. As you said, you want to be sure her PS values don't start increasing again.

If you ever happen to wake up during the night, try to grab a later cycle test. Assuming everything holds, then yes, I'd keep the dose through the week and then do at least a mini curve on Saturday so we can figure out if this is enough insulin (or too much). She looks like she's doing so well considering the steroids! And you're doing a great job taking care of her!

 

Her AMPS is 11.3 mmol/L (203 mg/dL). What do you guys think - shoot 0.5 units again? 1 unit? 0.75 units? I have to do the shot in 20 minutes, so hoping I hear from one of you... but if not, I’ll default to 0.75 units to see what that does.

Thanks again for all the help, guys!

 

One sec looking at SS now.

 

I think I’d hold 0.5 for now since you can’t monitor and it looks like it probably gave a gentler cycle last night. It’s basically the same as your PMPS so it should give a similar cycle.

 

Okay, I just gave her 0.5 units. Thanks for the advice

 

I like 0.5 u for now.

 

I just did her PMPS, and it’s similar - 10.4 mmol/L (187 mg/dL). I’m assuming this means that, for the time being, 0.5 units is good for her. Proceeding with 0.5 units now.

 

Good choice. Get a before bed test tonight.

 

That's great! I second the before bed test. I know it's kind of tiring what with your schedule, but as you get more data, you'll be able to make better decisions.