Help! Low BG

Hi everyone-

I gave Charlie his 1 unit of Lantus this morning at 7AM. I tried to do his BG before and it kept saying error over and over again. He’s been reacting fine to the insulin so I decided to go ahead and give the shot since my vet said it wasn’t necessary to check anyways. I’ve just been doing it on my own because of what I’ve heard. Anyways I went to go recheck his sugar now (930am) and it was 28! I couldn’t believe the number when I saw it because he’s never tested lower than 100. he’s acting just fine- actually the best I’ve seen him in months .. so I’m confused! I gave him some high carb treats but I am not sure where else to go from here

 

Retest to make sure it isn’t a meter error. Then call your vet.

Have some Karo syrup or honey handy, too. Do you have the hypo instructions handy?

 

Here is the link to hypo treatment instructions:
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

 

I can't stay on (have to leave for work), but just wanted to say: if that 28 holds up on the next test, I'd give Karo/honey immediately, and then head for the vet. 28 is way way too low, and you are at the very beginning of activity for this morning's shot. At the vet, they can monitor him much more easily than you can, and put him on a glucose drip to keep him safe.

 

Thank you everyone.. on our way to the vet now. This is getting kind of exhausting. But I’ll do anything for my baby

 

We just left the vet. He tested Charlie’s sugar with his monitor and it read 80- we then did it with mine and it said 27?!? We have the same exact glucometer and I coded it currently and in mg/dL. I noticed his said to code 38 and mine says 37. Has this ever happened to anyone before ?

 

Whew!!!!

Meters are allowed a certain variance, but that's too much at that low a BG (the allowance is +/- 20% of the "true" reading), so there must be something else going on. I don't know much about meters that require coding, but my understanding was that the code used depended on the batch of strips as well as (maybe) the species being tested? What brand is the meter? Maybe someone else here has specific experience and can help figure out what is going on. You don't want to have mistakes at the low end of BG.

In any case, it's good news that Charlie was apparently at a decent level according to the vet!

 

Sounds like you are using an AT2 meter? (it would be helpful to include meter type in your signature!) If so, both 38 and 37 are valid cat codes. The meter will not read until it has sufficient blood sample so that isn't the problem. I have had wonky numbers come up due to battery issues in a relatively new meter. I'd suggest you change the battery then check the meter with the test solution. If you got the AT2 kit, test solution should have been included. While the test solution only tests for a broad range, it will at least tell you if the meter is functioning as it should.

 

I would double check the code info on the vial of strips. Maybe you made a code error or used the dog code??

I have an AlphaTrak, and I have never seen a '37' cat code. Not saying they don't exist, I have no idea, but I have had a LOT of vials of strips and have never seen that code. I see 38 pretty often.

 

There are 7 valid cat codes known to us. They are 07, 08, 22, 37, 38, 92, 93. Been tracking them here and on my vials since 2015. There may be others but no one has reported any numbers other than these to my knowledge. Frankly I doubt any of these numbers set incorrectly would amount to as big a difference as Charlie's person (we'd love to know your name!) witnessed today.

 

My name is Amanda yes I use the alphatrak2. I reset it by pressing in the hole top. Seems to be working now. Based on the 80 BG the vet wants Charlie to stop insulin immediately and do a glucose curve test on Friday. I was surprised he wants to stop insulin completely. We just started Wednesday where is BG was 400+. Idk what’s going on

 

Hi Amanda, I see you are a nurse too! I am a retired R.N. YEAH NURSES!

Glad to hear the meter problem seems to be fixed.

Was Charlie already on the Purina DM Wet before diagnosis or did you change to that when he was diagnosed? Sometimes a diet change is enough to bring the BG levels down to normal levels and they can be diet controlled.

What did the vet do test wise to confirm the diagnosis? Fructosamine (similar to human A1C) as well as BG or just BG? If just BG in office, the level measured may have been very much stress related. Some cats can have BG elevated by as much as 200 points just from stress.

 

That's pretty common among vets, but we don't suggest it. 1U may be too much for Charlie, but there are lots of doses less than 1U

We like to keep them on insulin as long as safely possible which means gradually lowering the dose until they're on as little as 1 drop. We want to give the pancreas the best chance of fully healing. We all want a strong remission, not necessarily a fast one!!

 

Hi! Yay nurses!!! Charlie has just started the purina DM diet on Wednesday. They did the frutosamine test to determine he had diabetes. They did a urine as well. The vet said he’s never seen it come down that quick.

 

Yeah I don’t want to rush him going into remission. I want him to get the right treatment. I don’t want to lower his dose and feel like I should listen to the vet. It’s so hard hearing conflicting things. I will seriously be a mess if anything happens to him. I got him right after my mom passed when I was 20. He’s my baby

 

What was his diet before? If it was high carb, the diet change may very well have caused the profound change in his BG numbers. If I were you, I'd start testing Charlie in the AM and PM daily and see what he's up to so if his numbers start rising again and he needs to continue insulin you can catch it early. As Chris mentioned above, we don't recommend just stopping insulin. It's usually a gradual withdrawal that leads to a strong remission. I'm personally not a big fan of curves because they give you a snapshot of one day out of many and can mislead you if it happens to be a particularly good or bad day.

We understand how much you want to keep Charlie safe and that you want to follow the vet's advice to the letter. Testing everyday for a bit will give you peace of mind, doesn't contradict but adds to the vets suggestion and will allow you to ensure that Charlie gets the insulin he needs IF and WHEN he needs it.

 

My Chip was diabetic but that was many years ago before all of the current information was available. My vet had just gone to a seminar where low-carb food was discussed so we immediately switched him over. And I found this website.

The vet and I opted to hold off on insulin and carefully monitor the impact of the food change. I started home testing immediately and Chip's blood glucose plummeted immediately back into normal ranges due to diet change alone. We were one of the lucky ones because we caught it early and diet change alone sufficed. Most cats need at least a brief time on insulin.

Chip had always eaten dry kibble but we found that even the prescription diabetic dry food was too high carb and kept his BG elevated. I joked that all I had to do was wave a bowl of dry food under his nose to make his BG spike... he was that carb sensitive.

Many cats grow weary of the prescription canned food over time, not to mention that it's expensive and there's no magic ingredient that makes it prescription or better for diabetics than what you can buy off the shelf. You have to do what you feel comfortable with, but we found the food charts posted on this site to be invaluable in making our decisions.

Edited to add: as for your meter issues... Many of us have backup meters to use in just such instances. I have an AlphaTrak as well as a couple of human meters. The human meters will run a bit lower but it's great to have that "reality check" when you get wonky numbers.

 

So do I give Charlie his insulin ? Regardless of what my vet says?

 

I just rechecked and it was 85. Shouldn’t I hold it anyways ?

 

Would definitely skip the insulin at 85. I would wait until the vet does a curve unless you see a reading over 300(after testing twice, just in case). Even then you might want to reduce the dose. But I'm not as experienced as most people on here, so you might get some better advice. You haven't had an issue with ketones, right?

 

When you get a PS you're unsure about, Stall, DON'T feed and retest in 20-30 minutes....if the number goes up, it's usually fine to give the scheduled dose but you'd want to make sure to get a +1 and +2 so if you need to intervene, you can do it early.

If you need to get eyes on your post, change the subject line to something like "STALLING--NEED HELP" ….then you can change it again once you have help.

Have you fed or shot yet?

 

I would NOT give insulin at that reading. That is an excellent normal reading on the AT2 meter. I'd suggest you keep track of your readings for the next week or 2 and if his number goes up, then post for advice. Normally we recommend new diabetics not receive insulin unless BG is over 200 on a human meter and with the AT2 you might want to raise that limit a bit.

@Chris & China -Charlie has been sitting in the 80's on an AT2 meter all day and only started insulin a week ago. Doubtful stalling is going to change the picture.

 

Yes, I know.....but it's still something she needs to learn.....when to shoot, when to stall and when to skip.

 

@Chris & China - Agreed. It is something Amanda will need to know going forward IF Charlie needs insulin in the days to come.

 

Yeah, he's looking GREAT!!! Hopefully he's one of the lucky ones that was caught early and just needed a diet change!!

 

How many hours has it been since the last insulin shot?

Given he's a newly diagnosed diabetic, just went through a food change, and an 85 is a perfectly normal number on an AT, I would follow your vet's advice and NOT give a shot. However I'd also use this as an opportunity to continue testing and collect data. That will give you the reassurance that you're making the right decision by not giving insulin ... or show you that maybe you need to restart it.

As I mentioned earlier, a food change was all Chip needed to drop back into normal numbers. I checked multiple times a day in those first weeks to prove both to myself and the vet that we were on the right track.

One caution: if he remains diet-controlled, don't get lax and allow dry or high-carb food back into his diet. It's easy to do over time but often it's MUCH harder to get them into remission the second time around. More than one member has found that out the hard way.

Also, if you need to restart insulin, I'd suggest considering a lower starting dose ... maybe 0.5U BID.

Just my two cents...

 

Also meant to ask ... Has Charlie been given steroids recently?

Steroids can trigger transient diabetes in cats (my Charlie was a steroid-induced diabetic).

 

No steroids. The vet is confused as much as I am. I held the insulin tonight I’m gonna go by vets advice. I’ll do the glucose curve on Friday at home and we’ll go from there. Thank you all so much for your advice!! I appreciate it so much

 

My cat went into remission with diet change alone. It took about 3 days for his numbers to drop to normal range after the change. From about 360 to 105 in 3 days. Dropped another 15 to 25 points over the next week or two. Not as big a drop as you're seeing, but it can happen.

 

I have two AT meters and one of them keeps switching to 37. We will set it at 38 and the next time I use it I see 37.

 

My little one Simone went into remission from a diet change as well. Simone's glucose started to drop within days (like billysmon experience) and after 10 or so days she was off her insulin. No special food, just changed her from the vet supplied kibble to wet. Fancy Feast Chopped Grilled Feast pate' with a little Friskies Turkey & Giblets pate' mixed in, then a little water added as she liked is more sloppy.

 

I got a brand new meter because I figured the one I got was defective since my vets reading was 80 and my was 27. My new one(same as other-AlphaTRAK2 and is coded correctly) took it at 1245 and it was 63.. double checked at 1 and it was 123?! He did not eat or anything in between. Did I I get ANOTHER defective one.. anyone else have these issues with their meters? I want to be able to monitor Charlie at home but it doesn’t seem like this is possible with all these different reading

 

I have not had these issues with my AlphaTrak2. You said he did not eat in between, but had he eaten before the first test? It takes awhile after they eat before it impacts their glucose.

 

Was it the same batch of test strips? Maybe you have a batch that was mistreated (excessive heat or something?) before it came to you, and the strips aren't giving you reliable readings?

I'm not sure how likely this is-- I mean, I know that there are guidelines for storage and that kind of thing, I just have no experience with the real-world consequences of violating those guidelines and whether they might produce these kinds of variances. But maybe???

Does the AT allow you to test yourself (with a different code, for example), or are those strips to be used only for a cat? Or do you have a non-diabetic cat you could test?

 

It has only cat and dog codes, not intended for human.

Do you have control solution to check your strips??

 

Both readings are perfectly normal BG using the AT2 meter and that is what matters.

All meters have a variance allowance of 20% so if the first reading was on the 20% low side and the 2nd was on the 20% high side, Charlie's BG would be somewhere between 76 (1st reading) and 98 (2nd reading) ......not that far apart. No meter is 100% accurate. BG is constantly fluctuating from second to second and with a prey animal even more so. Had Charlie been playing before the first test and sleeping before the second? Did he just see a squirrel before the 2nd reading? If he is not really diabetic and his pancreas is working as it should, then his BG may very well be lower shortly after a meal than it is later once the food has been metabolized because the food will cause the pancreas to put out extra insulin to allow Charlie to take nutrition into his cells. Even if you took 2 readings with the same drop of blood in the space of a few seconds, you're unlikely to get exactly the same reading.

ETA: There is no code for humans on the AT meter so results would be way off.

 

Charlie had been sleeping and hasn’t ate anything since 8 AM. The strips I used were the ones that came with new meter. I tested my non diabetic cat and got 117.

 

But 63 and 123 are pretty far apart-- outside the 20%.

I like the idea of a squirrel sighting or a previous meal hitting the system in the intervening 15 minutes as possibilities, but I think it'd be good to do some technical checks too.

 

Now I just got 293 and 177.. using the same blood. Idk what’s going on!

 

Ah, , I just keyed in on that 63-- that's a low number for an AT. My money now is on just a single wonky strip or something like that, especially as he hasn't been on insulin for a while, correct? And that 123 is still in normal numbers for a cat (as you saw by testing your non-diabetic), so everything looks good other than the strangeness of that first number.

Edited to add: D'oh! Simultaneous posting that negates this message-- that 293 and 177 completely wrecks my "one bad strip" theory!

 

I know.. idk what’s going on! This is my second meter because my other one was doing the same thing. Maybe cause I got them off amazon???

 

Do you have another battery? The only time I had an issue with my AT2 reading wonky was when the battery was low but not yet giving me an indication it needed changing. Had the same thing happen with a human meter and had only used it for a few readings when it started acting crazy. I don't think ordering from Amazon should have anything to do with this as long as they were new products. Was the box all sealed up?

Stupid question: are you washing your hands before handling the strips? If you have anything on your hands it could cause wonky readings.

I'd take a break right now as part of those elevated readings could be Charlie getting a bit antsy due to the testing and your stress over the meter.

 

Yeah I wash my hands before. I called the company and it appears I have two defective meters because she walked me through control test. I was supposed to do the glucose curve test at home Friday to save money but looks like I’ll
Be spending 400-500$ for them to do it at the vet :/

 

Just a thought....

I know your vet may not agree but the other option would be to get a human meter to do the curve. It would be far more economical and you'd have a meter to keep checking Charlie going forward. The normal range with a human meter is lower but human meters have been used for our pets far longer than the pet meters which didn't even exist until relatively recently.

Many folks here use the Relion Confirm or Micro from Walmart. Both take the same small sample of blood as the AT2 and the strips are considerably cheaper than those from the AT2. If Charlie is staying in "normal" range, then his numbers should fall between 50 and 120. The odd number below 50 or above 120 is not cause for concern....as long as he usually stays within the normal range.

 

Thank you!!

 

And if you have two defective meters after following all directions from the company itself, maybe you can get your money back on those, too!

 

If I test twice in quick succession with my AT, the numbers are ridiculously off. I don't know if it needs time to reset or what.

If you don't trust your AT for a home curve, maybe get a Relion at WalMart before Friday? It would be a lot cheaper than $400+.

 

Thank you! I just talked to my boyfriend and he insist we bring Charlie in Friday to do the curve. He’s been all bent out of shape about all this just as much as I have. He says he will pay for the whole thing. So we will go that route. Thank you everyone for your input

 

Of course it is entirely your decision, but cats do suffer from vet stress and that can raise their glucose readings by 100 points (some as much as 200) which has led to more than a few very questionable diagnoses. I know a fructosamine was done however in the absence of doing certain other bloodwork, that test is NOT foolproof. My vet tried to tell me early on my girl was well regulated based on a fructosamine when I was still seeing very flat high home readings. Just food for thought for you and your BF. Please let us know how things go Amanda! You and Charlie (and BF) are part of the family now!

 

Thank you!!

 

I've noticed that I can get notably different readings on my AT based on the size of the blood drop and how well I "hit" the magic spot on the side of the test strip. I find the AT harder to use than my One Touch Ultra human meter. With the AT, there's no "windowpane" where I can see the blood being sucked up, so I often don't know how much blood the AT strip is getting.

It doesn't sound like there's anything urgent about having a curve done on exactly Friday. In other words, it's a nice target date, but does it warrant $300-500 for results that might be artificially inflated due to vet stress, being locked in a cage, and perhaps eating differently than at home? What solid data is that really going to give you? If the cat were going to live at the vet clinic, then it would make sense. If a curve at the clinic is your only option, then so be it. But given that you're successfully home testing, just having problems with the meter, I might consider waiting a few more days and trying to sort out the meter issues before defaulting to a curve at the clinic.

We usually find that the best results are obtained by doing a curve at home in the cat's natural environment, with the cat doing whatever it normally does, eating whenever it normally eats, sleeping and playing as usual. More than one cat has been overdosed because the BG values obtained at the clinic don't reflect "real life."

I might also suggest you pick up a human meter and strips. It will read generally lower than the AT, but it will still give you a clue about what is happening AND you can test with both meters if you want to (just don't be overwhelmed by what we already know will be differences in expected values). I know the feeling well of doubting the accuracy of a meter...and it's stressful. I can't tell you how many meter comparisons I did in my early years of feline diabetes!

I love my One Touch Ultra meter because it is reliable, rarely gives me wonky results, and because it runs "middle of the road" ... lower than the AT but not crazy lower like some of my other meters. Other members here have different favorites. And I often used my AT as a reality check, cuz even all these years later I still need one occasionally.

Just my two cents.

 

The AT meter does not read unless it has a sufficient blood sample... instead it will error out. It has a "grace" period in which you can add more blood to the strip but only on the same side of the strip. Add to the opposite side of the strip and it thinks its a bad strip. I always kept the sound on so the meter would beep when the strip was filled. I know this spooks some cats but they can be "desensitized' to it. The AT takes a miniscule amount of blood....about the size of a straight pin head. The only time I had a hard time getting enough blood on the strip was usually when my girl was running low normal range numbers. I am now wondering if too much blood would cause wonky readings?!HMMMM!

 

I actually think this is when I've seen the most wonky numbers...too MUCH blood. I rarely get an error code but almost instinctively know when I need to retest because the amount of blood felt suspect.

 

Interesting. Unfortunately it would be difficult to prove/disprove because most times folks don't get too much blood... if anything they get too little especially in the early days. I'm pretty sure I saw someone else recently having similar problems and wonder if there is a bad batch of AT meters out there. Mine is over 3 years old now.