? Help - Alex's GL jumping to 319

Discussion in 'Feline Health - (Welcome & Main Forum)' started by _Bobbie, Feb 13, 2020 at 8:28 AM.

  1. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Hello, I'm still trying to get things figured out for Alex. Over the last couple of days he has consistently tested under 200. There is one exception when he was 211, but I think he ate some food inside the two hour pre-test window. He has been quite a bit less active over the last ~24 hours, eating less and not drinking or eating much unless I put it right in front of him. I was in touch with my vet yesterday to let her know that I was doing home testing, and dosing less than the 2 units she told me to dose him. She felt like his numbers were looking good and I should continue what I am doing. I don't think he is hypo based on his numbers, but with his lack of interest in food and water, I am concerned something else is going on. I will get in touch with her again. But any thoughts about how I should proceed for now? His next shoot would be in the 11am-12pm range. I had been on an 11/11 schedule, but with all the stalling I am a little off that but trying to get back on. Thanks for any advice.
     
  2. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Are you testing for ketones?
     
  3. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    As a at becomes better regulated, their appetite and thirst decrease.

    Could he be having a GI flare up?
     
  4. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    I did this morning for the first time. I should add it to his SS notes. It was negative.
     
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  5. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Yes, that definitely makes sense about his less frequent drinking. But I feel like he is eating a lot less than he should be, and seems more lethargic. He has eaten a little more than 1/2 of a 5 oz can since last night. It could be a GI flare up, though he had very healthy looking poop yesterday.

    I've messaged the vet, and am waiting to hear back. But thank you for these ideas - they are helfpul!
     
  6. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Just to update here, I heard back from my vet. She advised stopping injections for 24 hours and monitoring glucose levels and appetite to see how he reacts. She wonders if he is trying to go into diabetic remission.
     
  7. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    Keep a close eye on the numbers. Vets will tell caregivers to stop insulin with numbers in a much higher range than when we suggest stopping insulin. We recommend tapering a kitty off of insulin. I'm concerned that an abrupt stop will put Alex back in higher numbers, but that's my best guess. Did you get any additional tests in today?

    FWIW, a cat might be lethargic if hypoglycemic and so far, there's no indication of that. DKA is another possibility but if your cat doesn't have a history of ketones, it's unlikely.
     
  8. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Ugh, I did his +4 about 20 minutes ago and it was 56. He ate some canned tuna, and is currently eating some kibble which I hope will get his level up. I will test again in a few minutes. He actually seems a little more alert, and his appetite is better. But I know an increase in appetite can be a symptom of mild hypoglycemia.

    How would you recommend tapering? I had been giving him .5 or .25. and then foolishly gave him 1 unit this (late) morning. I don't know what I was thinking, as that was clearly too much.
     
  9. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Update - 56 test was at 4pm ET. 4:30 was 62, 5pm was 68. So I think heading in the right direction, though probably within the margin of error for the monitor.
     
  10. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Keep testing to see Alex is continuing to go up, not down. Are you giving him food each time you have tested or just the first time you tested?
     
  11. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Each time. Is that the right thing to do? He ate less after the 5pm testing, but ate quite a bit of kibble at 4:30.
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Now that he is a bit higher, only give low carb food, or you could try leaving the food to see if he can stay up on his own. You will need to keep testing until he is past nadir and has stayed up on his own for 2 consecutive tests without any food then test again 60 mins later.
     
  13. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    I would suggest trying a dose of 0.25u and see how Alex does.

    Also, could you update your spreadsheet with your recent test data?
     
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  14. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Wow. I had to leave just after 5, and my husband was supposed to be home at 6 to test, but his train was late and he didn't test until closer to 7. Between 5 and 7 his GL jumped from 68 to 175. He had a small amount of tuna for a treat at 7pm but didn't eat anything else since. I just tested him when I got home at 9 and it was 319!! I will test him again in a few minutes, but what should I do in terms of insulin? Could the 1/3 cup of Iams kibble he ate at 4:30 cause this jump??
     
  15. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Also, I updated the title of the threat. Is that ok or does it make it more confusing?
     
  16. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Could definitely have been the kibble!

    How about trying Sienne's suggestion of 0.25U?
     
  17. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    OK, thanks, that sounds good. Should I give it before the usual 11pm dose time? I know I'm freaking out a little, but his GL has never been this high since I started testing, and it feels like it went up so fast! But please tell me if I am overreacting!
     
  18. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Those high numbers are startling when you see them, no question! But I wouldn't shoot off-schedule (unless you were wanting to change the schedule anyway). 300's isn't dangerously high for him to visit (there's a reason why the spreadsheet goes up to those red and black colors, some kitties practically live up there early in their journey :nailbiting: ). He's probably just spiked up due to kibble. It may take him a little while to work his way down, but he will come back down from that!
     
  19. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    OK, thank you so much for that reassurance! It is now at 364! I will shoot on schedule, and just take some deep breaths! Is it ok to feed him LC wet food, or should I hold off? Apologies for all the newbie questions.
     
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  20. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Answering my own question - of course no feeding 2 hours before shooting. But will plan to feed him after.
     
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  21. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Some excitement last night.
    You got some good help and remembered to not give any food for 2 hours before the pre-shot test.

    Hard to stay calm when you are so new to this feline diabetes journey.
    Anything you have not seen before can make you worry and panic.

    We actually have a member whose user name is Panic. I kid you not.

    Bobbie. I know it's rough right now. I know you have a ton on your plate, and life is full of responsibilities. But having a spreadsheet would help both you and us to help you better.

    Would you have a chance to set up the spreadsheet this weekend perhaps? Directions are step by step, you use a template we provide (so you do not have to "reinvent the wheel), setup can be done on a pc, laptop, tablet, smartphone.>>>>>>> Instructions are below.
    FDMB Spreadsheet Instructions

    What it all means is here in this link>>>>>. Understanding the Spreadsheet/Grid
    You start counting the + hours from the time you give the insulin.
     
  22. _Bobbie

    _Bobbie Member

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    Feb 9, 2020
    Oops, I was updating my signature and must have accidentally deleted the SS link. I just added it back.

    Thanks for your reassuring words, Deb, I really appreciate it. In a way, maybe going from such a low GL to a much higher GL in a short time, and now seeing his levels back down in blue territory was helpful. He survived! And I did too, haha. I've been in touch with my vet about this roller coaster and she advised me to hold off on insulin over the weekend as long as his GL stays under 200. I have been told on this forum that it is better to taper off from insulin, so I'm not sure what to do. Except for that one foolish dose of 1 unit that dropped him into the 50s, I have only been giving him .25 or .5 units, and that has been keeping him well regulated. I know it has only been a short time since his diagnosis, so there isn't a lot of data. I'll check him a few more times before his usual 11pm shot, and then I'll have to decide what to do. Any advice?
     
  23. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Vets often consider "regulation" to be "good enough" for diabetic cats.
    Most of them do not encourage home testing.
    They do not adjust insulin doses by such small amounts, 0.25u or 0.5U as we do here.
    The diet recommendations that are made are not always the best for a diabetic cat.
    We know that some diabetic cats can have more normalized non-diabetic cat BG levels. <80 md/dL
    Some vets are happy to have the cat below "renal threshold" where there is no glucose being filtered out by the kidneys and dumped into the urine. But still higher than the blood glucose levels should be.

    Your vet started your cat Alex at 2U and you had already reduced that to 1 U.
    Then we suggested you reduce to 0.25U because of those low BG readings you got on 2/13/20 (yesterday).
    "Bouncing" last night, BG's look fairly decent today, but a bit higher than we like to see.

    Worst case, the BG readings at your vet were due to stress and Alex did not need that much insulin.
    Flip side of that is, it's too early to stop the insulin and you start Alex back up on insulin again.

    Think of this as an opportunity to do a short OTJ trial this weekend.
    The option is yours. You hold the insulin syringe as we tell people. You are there and know your cat Alex better than we ever will. "Know thy cat."

    What do you think?

    What is Regulation?
    There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":

    • Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
    • Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
    • Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
    • Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
    • Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
    • Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin
    There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a glucometer calibrated for humans. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure.
     

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