Help, possible hypo w/Alphatrak.

Hi-

I thought I'd start a new thread. I had one at viewtopic.php?f=28&t=97169 dealing with Kitten not eating.

He's done better today...we're up to 4.2 oz. since 6:30 AM (cst). Brief background: He was diagnosed on 6/5/13. Had his first curve on 6/7. They gave him one unit Lantis. When I picked him up at the vet, they said to give him 1/2 unit 2X day. He's been very inappetant since then, but slowly eating more.

I had an AlphaTrak, which I dropped yesterday. I ordered a replacement AlphaTrak 2.

I've been feeding him small meals today. However, I have NOT given any Lantis.

The meter just came, I set it up and tested Kitten. His BG was 245. He had eaten apprx. 1 oz. of Fancy Feast sole cod shrimp about a half hour prior to testing.

Is this a decent number?

 

Re: Just Tested-Need Advice

We use reference ranges for cats on human glucometers; leave your numbers alone, please!

Adjusted for AlphaTrak

< 70 mg/dL = headed to hypo if not already there; implement hypo protocol. Also, dose decrease for long term diabetic

< 80 mg/dL = caution, could be heading to hypo if early after shot. Dose decrease for diabetics < 1year duration

80 - 160 mg/dL = well controlled

210/230/270/310 mg/dL = depending on your data source, this is the renal threshold where glucose starts spilling into the urine.
At these levels, you may wish to test for urine or blood ketones. If your cat has ever had diabetic ketoacidosis, you may want the pricier blood ketone meter to get the most accurate measurement you can

 

Re: Just Tested-Need Advice

Still very new at all this.

When you say "leave my numbers alone", do you mean, I should give exactly what the ALpha Trak 2 reads?

My Alpha Trak 2 manual says greater than 250 is considered high.

 

Re: Just Tested-Need Advice

Yes. Do not adjust the values; leave them alone.

It may be helpful if you go back into your signature, highlight the line with your meter, and increase the font size so it pops out a bit and catches the eye.

 

Re: Just Tested-Need Advice

OK. Thanks!


My Alpha Trak 2 manual says greater than 250 is considered high. So is his reading of 245, a half hour after a midday snack decent? Granted it's only one reading today.

 

Re: Just Tested-Need Advice

Yes, it's a decent number. Not the best but ok, especially since we know it is higher with the food influence.

I have put all these numbers in terms of what you will see with testing on the alphatrak. Numbers in parentheses are for human meters.

Renal Threshold 260-310 (230-280) depending on what source you consult. A number above the renal threshold means that excess glucose is being dumped into the urine.

Normal non-diabetic cat (or food controlled diabetic like my Wink) 70-150 (40-120)

Regulated 130 210 (100-180)

Any number above 330 (300), you should be testing for ketones.

Wikipedia is one of my sources http://en.wikipedia.org/wiki/Diabetes_in_cats

 

Re: Just Tested-Need Advice

Thank you for the clarification

And I realize it is only one test too. But I am looking for any nugget of good news I can get.

I also bought some ketone sticks and I'm going to try and get a sample this evening.

 

Re: Just Tested-Need Advice

SO I did another BG 1/2 hour after Kitten had his early evening snack...BG was 210. Because I did not have my BG meter this AM, I did not shoot.

I also managed to get a urine sample too. NEGATIVE for keytones! Not a trace...nada! Used three strips to be sure!

I plan on testing after the last feeding tonight, then shooting 1/2u Lantis.

What BG number should I or shoud I not shoot?

Thanks!

 

Re: Just Tested-Need Advice

How much did he eat today?

We dont advise newbies shoot under 200 until they have enough data to know how the cat will behave. However eventually your cat will get regulated and to keep him in good numbers you will need to learn to shoot low.. you shoot low to stay low. So its important to start tracking Kittens BG trends so you are prepared.
Can you set up a spreadsheet? http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

The first time you need to shoot under 200 (which may be soon) dont feed and dont shoot and come on here and an experienced member will walk you through it. Also dont feed two hours before the shot so that you know the preshot BG isnt influenced by food.


Wendy

 

Re: Just Tested-Need Advice

I intend to setup a spreadsheet. It's been a priority just getting him to eat enough and we seem to be getting there.

I tested him after his mid-day meal using the Alpha Trak 2 that came in this afternoon and he was 245.

I'm stoked though, no ketones!

 

Re: Just Tested-Need Advice

every little bit of good news is good... So when is preshot?

 

Re: Just Tested-Need Advice

About 9:00 PM (cst)

 

Re: Just Tested-Need Advice

About ketones.... they can occur at ANY number. Do not think that below 300, your cat will not get ketones.
What you want to do is test your cat's urine at least once a day in the beginning because some cats are just prone to getting ketones and they happen at lower numbers for those cats as well as at higher numbers. To state the ketones occur only when numbers are high is a fallacy.

My cats did not ever register even a trace despite both were in quite high numbers for some time. The majority of the time, testing their urine was difficult because they both had their back ends facing the wall. Some cats are shy and don't like to be watched, so people have resorted to laying the strip in the urine pool for the required length of time. Many people here can give you their tips if you have problems.

Going by human meters, renal threshold is more like 200-240 and differs for each cat, and non-diabetic is closer to under 120. Regulated is the point you reach when your cat has nice smooth curves and numbers under 150, and hopefully under 100.
Just add on around 50points to those numbers and you've got your AT meter readings.

Gayle

 

Re: Just Tested-Need Advice

Thank you Gayle.

I intend to ketone test at least once a day for the forseeable future. I have been able to get a sample using an old soup ladle.

I just did his preshot BG test and it was 193. He then ate 2 oz. of food (7.2 oz. total today)

I'm hestiant to shoot now.

Thoughts?

 

Re: Just Tested-Need Advice

I wouldn't. You are under 200 and don't have enough data to know what will happen next, he could go up or go spiraling down. Skip the shot and get a test in 2-3 hours to see what he does next without the shot.

We need that SS

 

Re: Just Tested-Need Advice

OK, I'll skip it. Not sure if I can do another on in 2-3 hours.

 

Re: Just Tested-Need Advice

OK the next time you are not sure about giving a shot or not, don't feed. What you can do instead is to wait for 15min or so and test again..... you want to see a rising number. Now that you have fed him a bit, he will likely rise a bit higher.

Your dose is only 1/2 unit yes? I would think it is OK, if you want to shoot; just get another test at about +2 or +3 to see where he is.
If you test at bedtime and you are not sure if the number is too low, you can give him some food, even some medium carb to see him over the nite.
If you can't do more testing, then you may as well skip because you need to watch for your cat going lower at nite, as some do.

Gayle

 

Re: Just Tested-Need Advice

Yes, he is supposed to get 1/2u.

I would not be able to test in 2-3 hours.

 

Re: Just Tested-Need Advice

I woke up feeling lousy this morning...picked up some kind of bug. I am sure Kitten feels better than me right now.

His AMPS test was 221. I fed him and he ate 2.6 oz. The little guy seems to be getting his appetite back in a good way.

I gave him .5u of his Lantis.

I'll try and test him in +2 or +3 or so.

 

Re: Just Tested-Need Advice

Sounds like you need some :smile:

 

Re: Just Tested-Need Advice

Thanks, Wendy. I can always tell when I have a bug. I am a coffee drinker, but when feeling rotten all I want is hot tea. ANd summer bugs really stink :lol:

My sweet biy ate, got his shot, and is now napping. Does yours ever stretch out n a chair then they rotate their head upside down mid sleep? It's like how do thye NOT get a crick in their neck, LOL.

 

Re: Just Tested-Need Advice

I just took a +2 reading and it was 63 on the ALpha Trak 2.

What should I do, if anyhting?

 

Re: Just Tested-Need Advice

Dan,

Give 1 teaspoon of low carb food and test again in 20-30 minutes. Get the karo syrup ready but don't give any yet.

ETA: anything below 80 on a Alphatrak needs some food. I'll be here to monitor.

I just saw your note in your signature link that the vet thinks the diabetes is steroid induced. That is very common. The good news, is that steroid induced diabetic cats have a very high chance of remission. I forget what the percentage is but I believe it is over 80% within the first couple of months of treatment and proper low carb diet.

Hope your summer bug doesn't keep you down for long. Sending healing vines and plenty of feel better vines.

 

Re: Just Tested-Need Advice

Would you please go back to the very first post in this topic, change the icon to the 911 icon, and change the subject to Help, possible hypo w/Alphatrak.

Do you have some gravy type canned food on hand? Plenty of test strips?

Add one drop of karo syrup to the LC (low carb food) if he hasn't eaten it already.
If he has already eaten the food, smear the one drop of karo on his gums.
That is a fast and steep drop and we need to bring those numbers up.

6/12
AMPS 221
+2 63

 

OK.

Gave him a bit of canned food and rubbed 1 drop of Kyro on his gums.

 

Just tested again...still 65.

 

Do you have a can of gravy type cat food?

Squeeze out a teaspoon of that and let him eat it. We don't want him to get full, so only the gravy part if you can.

If no gravy type cat food, rub a bit more karo on his gums, a 1/2 teaspoon and test again in 20-30 minutes

 

No gravy...rubbed a bit more karo on his gums.

 

I also tested the AT with the testing glucose and it is working OK.

 

Thank you. Next test 30 minutes from the last one.

Did he eat the 1 teaspoon of low carb food?

 

He ate a bit of it. I also rubbed several drops of kyro n his gums too.

 

How long since the last test?

 

25 min.

 

Test now please

 

I think the AT is working fine. BTW this means a dose reduction tomorrow to 0.25IU.

Time for another test.

This is early in the cycle Deb I think we need to bring him up -lets see where he is now but if he is still low I am thinking 2 tsp of HC or 2 drops of syrup in LC

Wendy

 

BG at 66.

 

He isnt coming up enough. Give 2 good size drops of karo this time in 1 tsp LC and retest again in 30. We will be here watching. It might bring him up and wear off though so we need to continue to be vigilant.

How is your supplies of strips?

 

I'm good on strips.

 

6/12
AMPS 221
+2 63
+2.5 65 with karo
+3 66 with karo

I agree, we need the number to come up more. He's a long way from nadir.

If he won't eat the LC food mixed with karo, you need to smear more karo on his gums.

 

Ok good. I have also asked for more eyes to come over. Did you give that syrup?

Also any symptoms?

If my cats wont take the syrup I mix it with a little butter. they love butter but just a small pea worth.

 

That's a rapid, steep drop.

We are trying to get his numbers up above 80. Prefer 100.

We are a long way from nadir.

We can keep trying to raise the number with the karo and food, or you can take him to the vet.

Just in case, how far away is your vet?

Do you have someone to help you? To drive to the vet while you give the karo.

 

I am alone at home.
No symptoms. He ate some food with the karo on it and is walking fine too.

I called my vet, they said feed him aand monitor him. No insulin tonight or tomorrow. SHe thinks the wet food mey be regulating him better than expected.

 

Wendy, He doesn't have any high carb food on hand. Only the karo. Kitten also did not want to eat the LC food mixed with karo, Only a little bit Dan said.

 

Hi Ladies,

Some symptoms of hypo here (from the hypo sticky) for reference:

Some cats may have NO symptoms whatsoever, but here are the most common ones:

MILD HYPOGLYCEMIA
Sudden ravenous hunger
Shivering
Weak or lethargic

MODERATE HYPOGLYCEMIA
Disorientation
Trouble with vision... bumps into furniture
Poor coordination, such as staggering, walking in circles or acting drunk
Changes in head or neck movements
Restlessness
Urgent meowing
Behavioral changes, such as aggressiveness

SEVERE HYPOGLYCEMIA
Convulsions or seizures
Unconsciousness


TREATMENT

During treatment for hypoglycemia, try to test every 15 minutes until you see the bgs begin to rise. Then continue to test until you are satisfied that the cat is out of danger.


viewtopic.php?f=28&t=15887

The above list is not exhaustive. Be aware of any changes in behaviour.

 

I would add very dilated pupils that do not contract with light to the hypo symptom list <60 reading with the Alphatrak.

 

We need to get a good couple of drops into kitten as he is currently in hypo territory. Can you rub it on his gums to make sure he gets a good amount? or put it on fav treat? (even a high carb piece of kibble)

 

Two big drops of karo, 1/2 teaspoon.

And another test please.

 

OK..Checked his pupils...they constrict and are not wide open.

I gave him some more karo and more LC food.

 

ok good - when was last test? we need to test every 30 for now.

 

Just tested... at 11:20 cst...BG at 75.

 

Yes. He's not happy with this every 15 min deal.

Should I keep feeding him a little at a time?

 

ok good - another test in 30 is fine. Give him 1 more drop of syrup in 1 tsp LC if he will take it, or rub into gums.

This increase is probably just the syrup and he might drop when the sugar wears off..

 

OK.

God bless you all! This is a really harrowing experience.

 

6/12
AMPS 221
+2 63
+2.5 65 with karo
+3 66 with karo
+3.5 75 with 1/2 t karo

He has come up a little bit, but I want to see more of a rise. Please try him with 1 teaspoon of LC food with a drop of karo mixed in.

 

Thanks Deb.

Dont worry you are doing fine. We want him rising without syrup before we can stop worrying.

Wendy

 

I tried getting him to eat some food but he's not interested.

 

Syrup on the gums again then please.

When did he eat brekkie?

 

OK

2.6 oz. at 7:45 AM (cst)

Is this normal, that they won't eat when they're low?

 

If the cat is feeling nauseaus at all, yes. Ever get so hungry, your stomach was upset? Similar.

Hang in!

 

Yes with the hunger. SO when his BG goes up he should feel better?

Hanging in....I'll be retesting in about 10 min.

 

Just tested...BG 92.

 

ok great! no syrup this time. another test in 30.

 

OK.

SHould I keep trying to get him to eat some food?

EDIT: AT 12:10 PM (cst) he ate abiut a teaspoon of LC food.

 

thats fine to give him LC.

6/12
AMPS 221
+2 63
+2.5 65 with karo
+3 66 with karo
+3.5 75 with 1/2 t karo
+4 92. LC

Wendy

 

OK.

DO I keep testing every 1/2 hour? He's really getting annoyed.

 

let see where he is in 30 given he wont have had the syrup this time. If he stays up or goes higher maybe we leave it an hour. If he drops then its another test in 30. Good news annoyed might help increase his BG too You are giving LC treats after you test?

I am thinking he might hit nadir soon or start to bounce too which will help..

 

I am due to test at 12:20 PM. Should I wait until 12:50? That'd be a full hour since last test.

 

No let's do 12.20 , that's +4.5 right? And then we can decide from there..

 

12:24 PM (cst)...BG 86.

 

Remind me when he last had syrup? An hour ago?

 

Yes. I believe so. I'm so frazzled.

 

It's ok, you are doing great. How about we do the next one in an hour but give him a little more syrup right now to ensure we keep him up? Normally I would have you wait and see but if he is getting too annoyed that's not good either.

So give some more syrup and measure in an hour and let me know. I will be here waiting to see. We want to be sure he is still going up when the syrup wears off and doesn't suddenly nose dive.


Wendy

 

OK. I'll give some karo. He's not really interested in any food right now. But he is pretty alert.

 

Ok cool. C u in an hour. Go grab lunch and chill.. And keep an eye on him just in case.


Wendy

 

OK.

Thanks SOOOOOO much!

 

That's the hope, so long as no other illness is happening.

 

Yesterday, we did not guve him any Lantis. He ate 8.2 oz.

 

OK. I just tested at 1:30 PM (cst) and BG was 78.

 

6/12
AMPS 221
+2 63
+2.5 65 with karo
+3 66 with karo
+3.5 75 with 1/2 t karo
+4 92. LC
+4.5 86 with karo
+5.5 78

ok you can either give more syrup in test in an hour, or skip syrup and test in 30.

Wendy

 

I think I'll opt for some syrup and test in an hour. I've offered food but he's not interested.

Have we passed nadir?

EDT: I gave him a bit of karo and he's eating some tuna now too.

 

The nadir for Lantus is generally between +5 to +7 hours after the shot, normally. Since the dose was enough to take him low, it may take longer to wear off.

He needs to be solidly above about 100 mg/dL, twice in a row, to relax, especially if he isn't eating still. Syrup wears off pretty quickly.

 

I agree with BJ but the problem is that we are still giving syrup right now and its not bringing him up. Next time we might have you skip the syrup and do half hour tests again to see if he comes down again.

See you in an hour.

Wendy

 

He had some karo over an hour ago, then I tested.

I just gave him a smear on his gums and he ate a little tuna.

Should I smear a small amount on his gums avery 10 min. or so?

 

Just keep doing what you've been doing.

You might try offering a pea-sized bit of canned food at a time on a finger, or even putting it in his mouth to see if he'll eat some that way. The protein in it will result in sustained glucose levels.

 

I just got him to eat about 3/4-1 oz of LC food.

ANd based on my temp. of 101.4...I think Kitten is staring to feel a bit better.

 

Just tested at 2:55 PM (cst)....BG was 187, one eight seven.

An hour ago he did get a little karo smeared on his gums and did eat about an ounce of LC food.

 

ok hold off now on the syrup. you are good now. what was his BG an hour ago?

 

Would you say this was right?

6/12
AMPS 221
+2 63
+2.5 65 with karo
+3 66 with karo
+3.5 75 with 1/2 t karo
+4 92. LC
+4.5 86 with karo
+5.5 78 with karo
+7 187

 

Wendy,

That looks correct.

Could that last big rise be due the the food he ate? ANd what do I continue to keep doing? Trying to keep him eating LC food?

 

I suspect he passed nadir. So now just feed him etc as usual. Maybe another check in a couple of hours to see where he is at.

tonite - you going to reduce the dose or skip?

 

I'll check him in say 2 hours. He's sleeping right now. Hard to believe that nadir and 1 oz. of food can cause a big jump. Wow.

The vet said to skip tonight's dose and tomorrow as well. SHe said he MAY be resolving this on his own, since they believe it was Depo Medrol induced and the "cold turkey" switch from dry to all wet may be happening.

I can't THANK you enough!!! ANd all the others that replied.

There's NO way I would have gotten through this without y'all!

 

ok cool let me know how it goes in two hours.

Through tonite and tomorrow get some spot checks to see how he is doing - we want him 50-130 as much as possible. If he cant sustain that he might not be quite ready for OTJ yet in which case your next dose is 0.25IU.

Wendy

 

.25u!!!

I can barely see the 1/2u :lol:

 

Lol.. Do your syringes have half unit markings? Heres how it looks

 

Yes, they do have .5u marks. But those are hard to see too. I'll get a magnifying glass; that may help.

 

Thats a good idea. Also can you remove the 911 from your first post? No more emergency now!

 

I removed the 911 from the post.

He has been sleeping for 2 hours and not eaten. Just tested him.

His BG was 131. We're going to see if he'll take some food. On the bright side of all this...I got a lot of testing practice in.

Thankfully, my wife is now home. She has 2 patients to look after. :lol:

 

lol. Leave him be now I think he is out of the woods. Maybe another test before bed.. and a hot toddy for you
Wendy

 

Due to this incident, it is possible he may be more sensitive to insulin.
If you aren't up for staying awake all night, and he tests barely above 200, you may want to skip tonight.

They make syringe magnifiers, visor magnifiers, eye glasses clip on magnifiers, and of course, free-standing magnifiers. I use the Carso Clip 'n' Flip with my glasses and they were great. Avalable from our shopping partner Amazon.

 

The vet said to skip tonight.

Thanks for the magnifying tips.