Help, blood glucose of 34?

My cat was diagnosed with diabetes 2mo ago and gradually ramped up to 3 units of insulin (lantus) per day. After about a month, I switched her from crappy dry food to exclusively wet food (Fancy feast classic line, after doing some research here).

Today we went for a glucose and fructosamine test and her glucose level was 34! Down from 420 when she was first diagnosed. The vet assistant said this was quite dangerous and the vet would call me today to talk it over. I asked if I should skip the insulin tonight, and the assistant said to wait for the call.

Well, it's the end of the day and almost time for my cat's next insulin injection and the vet hasn't called (they closed at 2pm). I'm not sure what to do. Skip the insulin tonight? Only do 1 or 2 units instead of 3?

Any advice would be really appreciated. Thank you!

 

Hi and welcome to fdmb
Have you retested since you got the 34.? That is reallylow and when that happens you need to give some high carb food and/or some honey to bring the number up over 50. I'll post this first so you know what to do. I would not give any insulin tonight. I'll post more in a minute.

 

Thank you! Will skip the insulin tonight.

We have not retested since the test at the vet. We don't have any ways to test at home. The timeline was:

6:30am: 3oz can of wet food
6:45am: insulin
1:00pm: glucose test at the vet
6:30pm (30m ago): another can of wet food (and a small bit of dry food too because I've gotten paranoid after reading about low blood sugar)

She seems to be acting normally.

 

I think it is disgraceful that the vet did not see you immediately with a blood glucose level that low! And not to ring at all is negligent!

My recommmendation would be for you to go out and buy a human glucose meter from Walmart or a pharmacy and start testing the BSL(blood sugar level) yourself. It might sound scary but it is easy to do and we will help you.
We test before EVERY insulin shot to see it is safe to give the insulin.
Then we test during the cycle to see how low the insulin takes the blood sugar.
This is the only really safe way to do it. Going to the vet periodically is like playing Russian roulette. Cats often run higher at the vets so the reading are not true readings. It will also save you money.

We also only increase by 0.25 (1/4) unit increments. And it is the nadir( lowest point in the cycle) that determines the dose.
You definitely need to reduce the size of the dose.

Do you think you would be able to get a meter and start testing the BSL?
Can you tell us what type of insulin you are giving at the moment.

 

I see you are using Lantus. With Lantus you are able to feed during the day as well as before the shot. In fact it is preferable to give some food at say +3 and +6 (3 and 6 hours after the insulin) or +2 and +5.... these are just example times........ the insulin is usually (but not always ) strongest at about +5 to +7 so it is a good idea to feed then to ensure the BSL doesn't drop too low.
Manyof us uses timed feeder so kitty can get food at other times during the day and night.

 

Thank you. Yes after this scare I think it might indeed be best to start testing ourselves. I will research this more and try to pick something up tomorrow. Thank you for your help Bron!

 

That is a great decision!
Here is a link to how to test the BSL
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
It will take a few days to get it down pat, we all started not knowing what to do, but in no time it will become easy. Always ask for help if you need it. We are always here.
In which country do you live?
If you feel up to it tonight you might like to fill out your signature, which gives us info about your kitty so we don't have to keep asking you the same questions over and again. Here is the link
http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/

When the vet increased the doses, did you go up in 1 unit increments? Or less?

 

Will do. We live in the United States, California. We went up in 1 unit increments. (1 -> 2 after a couple of days; 2 -> 3 a week after that).

 

Then I think you need to go back to 2 units, maybe less, but it would be preferable to start testing as soon as you can.....much safer.
I will just get another opinion re the dose you should go back to.
@Bobbie And Bubba @Chris & China what do you think re the dose. 2 units or maybe back to 1 or 1.5 units??.......Not testing yet and had a low of 34 at the vet today.

 

Just tagging @Chris & China again in case the other tag didn’t activate.

 

How much does Chloe weigh?

 

I think the safest dose to give at the moment after what has happened and the fact you are not testing yet is 1 unit, providing your kitty has not had a history of ketones with the diabetic diagnosis. If you can buy the meter and start testing we will be able to see if you need to increase the dose or not.
I see @Bobbie And Bubba are online. What do you think Bobbie?
I have to head for bed now as it is almost midnight and it is probably almost time for Chloe's am dose. Bron.

 

Unbelievable that they did nothing to intervene when your cat's glucose was that low!!! Then, the vet did not even call you back!!! That could have turned out horrible. I am glad it did not, and I am glad you are here. You will get a lot of help here from people who l live and breath feline diabetes.

 

I agree totally.

 

Thank you for the replies everyone.

13lbs at the vet yesterday, up from 12.5 when she was first diagnosed two months ago (and down from 16lbs at the start of the year)

Sorry, I didn't check the forums this morning and skipped her am dose as well out of caution.

I bought a Contour Next device and checked her just now at 1pm, with a reading of 145. I fed her 1 can of wet food this morning at 6:30am.

No history of ketones with the initial diabetic diagnosis.

I've started a spreadsheet for Chloe and added it to my signature. I'll check again before her shot tonight at 6:30pm, unless I should check more frequently? I'm home all day today, and at work from 8am to 5pm M - F. I'll be able to do a full curve next Saturday probably.

Still no call from the vet! They are closed today though. I'll call them tomorrow morning and share what they say.

 

I am so glad you bought a meter and are testing. And great there were no ketones.
Can you do a couple of tests during the afternoon, so we can see what is happening. A +11 ( an hour before shot time) would be good to see....then you could post and ask what you should do for the PM shot. You would still need to get a +12 BSL (blood sugar level) but doing a +11 today will give us time to decide on a dose.
Well done getting the SS up and running.
Could you try a little experiment? Test Diago and then feed him some food...then two hours later test again. Document in the remarks column when you feed him...that is helpful info for us. If his pancreas is working, his BSL should go down a couple of hours after food.
I am amazed your vet has not phoned. That is terrible.
Areyou able to pop home at all during the day to test when you are at work?

 

Take the food away for the 2 hours Preshots because we don’t want food influenced BSLs for the Preshot numbers. This rule applies always.
It is fine for her to eat during the day and night. Just not for the 2 hours before the Preshot number is done.

 

@Peter and Chloe Please post the BSL before you give any insulin tonight. She may be too low to give any

 

Hi Bron, I just checked her BSL at 6pm (+11) and it's 218. I'm thinking 1u tonight at 7pm. Does that sound reasonable? Thanks!

I'll check again pre-shot.

 

Let's see where she's at at PMPS, but 1U sounds a lot more reasonable to me!!

If you can plan on it, getting a +2 can be really helpful in having a better idea of what might happen later in the cycle too.

If the +2 is lower than the PS, it's your "early warning" that she might be going much lower later in the cycle.

 

See what the Preshot is, but I think 1 unit should be ok. Are you able to check the BSL during the night if necessary. That would mean setting the alarm and getting up to check the BSL?
Do you have some higher carb food and some honey or Karo in the house in case it is needed?
And plenty of test strips?
Unless Cleo drops too low, you will need to stay on 1 unit for at least 6 cycles (3days) to let the depot fill. Then, if needed, you would increase in 1/4 (0.25) unit increments.
Do you have 1/2 unit syringes or the 1 unit syringes? The 1/2 unit syringes make it easier to dose the smaller increments. When buying the syringes make sure you get the U-100 3/10ml 8 mm 30 or 31 gauge syringes

 

Preshot was 215. Dosed 1u. I have dry food and fancy feast gravy lovers as a high carb option. I have 1u syringes, will ask the pharmacist for 1/2u next time. Will check +2 at 9pm. Thanks Bron!

 

Hi folks, quick update on Chloe: after a few days of 1u and a wet-food only diet, her pre shot numbers started to go green so I dropped the dose to .5u. She's had quite steady blue numbers in the low 100s for a few days now. Should I start considering stopping insulin?

Chloe's Spreadsheet (I should probably be testing more but haven't been finding the time)

By the way, the vet called back on Monday and suggested dropping the dose to 2.5u (at the time, I was doing 3u). I promptly ignored that, I'm pretty sure it would have killed Chloe...

 

What are her numbers? Not the color, the actually numbers?

 

have family over, getting ready to open presents. I will check back. I have a situation going on myself

 

12/19 - PMPS 68, switched to .5u
12/20 - PMPS 100
12/21 - didn't test, stuck with .5u
12/22 - +6 was 103; PMPS was 107

Thanks! No rush, will stick with .5u for now.

 

Hi Peter,
Are you able to get some in between numbers? At the moment you are only getting some Preshots and one day where you didn’t get the Preshot but a mid cycle test and we don’t know how low the dose is taking her. She could be dropping quite low with Preshots of 68 and 100. You really should be testing before EVERY shot to see it is safe to give the shot and please try and get a mid cycle test for as many cycles as you can. It is the lowest point (the nadir)which tells us if the dose needs to be changed, not the Preshot.
I can’t believe your vet did not ask you more about Cleo and the dose. I hope he doesn’t have any other FD kitties.

 

I’m also shocked about the vet not asking! And I 10000% agree about testing before giving any insulin especially with the low numbers already. There have been many times that I could’ve killed my cat if I had not tested and just gave him insulin. Vets that don’t push that issue IMO make me so angry and put their patients in danger. I had to stop seeing my old vet because she didn’t support this, and she didn’t like that I do my own curves, and don’t buy their dry food and that I don’t use & buy the expensive “ animal only” meter from them. In other words, she was more worried about getting money then the well being of my furbaby.