How long does the post-hypo funk last?

Bowie got switched to a lower dose (from 4 to 3 U) last weekend. This weekend, I did a BG curve and he had gone hypo (44) at 3 hours post injection. We spent the day trying to stuff him with high carb crunchies and managed to keeping him OK. The lowest he went was 39 , and we skipped the dose at night. He ate his dinner very late. I must say, thank goodness for an awesome friend/vet who called me back as soon as I texted her values and coached me through caring for him. She wants to lower his dose again to 2U. Once his numbers starting going up, she told me to skip his night time dose and start again in the morning with 2U, but only if his BG was above 250 and he eats.
This morning, he was at 289 first thing in the morning. We recently dumped the WD wet diet because he was refusing to eat in the morning unless we mixed in fancy feast. I fed him 2 cans of ff and it was a struggle to get him to eat half of that. I spent 2 hours trying to get him to eat. He seems really tired out and just wants to sleep. I have a friend who is diabetic and who says that a very bad hypo spell makes you feel like crud for days. I rechecked before going to work and he was at 313. I didn't dare inject him. My husband is back from work now and says he looks wiped out and just wants to sleep. I'm thinking he's just feeling crappy from what he went through yesterday.

 

I don't know how long a hypo makes them feel ill but it's not surprising that it would. I like the idea of going down to 2 u to see if the numbers become less variable. Your ∆BGs are quite large at the higher doses.

 

That's quite the rebound Bowie had yesterday..... down to 39 and back up to 351. I'm sure the after effects of the hypo are playing a role in how he's feeling today. He's been without insulin for over 24 hours now and that too is likely affecting his energy level since he needs insulin to properly metabolize the food he eats. Even if his appetite is still low tonight, I'd try not to skip insulin again even if it means giving a reduced dose. It's quite possible that once he gets back on track number wise, his appetite will improve.

 

Thanks MrWorfmen's Mom. Good point about cells needing the insulin to use the BG energry. Yeah, that 315 was after giving him a bit of crunchies all afternoon and after he had soft food. I sure hope he's hungry tonight. We are not giving him access to the food he didn't eat over that 2 hour period this morning. We want him hungry/without a half full belly to try and keep him on track. This is hard, and we are second guessing ourselves left and right. Thanks for the input.

 

Also, vet had switched him from 4U to 3U on 1/22/17, because she thought he was getting the Somogyi effect at the 4U dose. This will be the second dose change in a month.

 

ProZinc is an in-and-out insulin so you can make relatively frequent dose changes without interrupting the "depot" as you would with Lantus or Levemir. Some people with a lot of data and dosing experience use sliding scale dosing to achieve better BG control - ie., a dose varies with the range of the AM and PM pre shot number.

 

That's the problem when they go too low. You gotta get them up but then you deal with the after effects. Important thing is you got him through it safely and he'll get back on track. The lower dose should help avoid any more surprises.

 

Desperate times, desperate measures. My husband called me to give me an update that he's awake and alert now and seems much better.

 

Good to hear he's recovering!

 

Glad he's feeling better! It's possible that kicking the WD is what is causing his BGs to be lower. FF is a low carb food, so it's probably helping him get those lower BGs.

 

Holy Smokes!! Thank God I had the sense to test his glucose this morning before giving him a shot. It was 61!!!! I came home from work last night. We fed him, and I gave him the new dose, 2U. I didn't test last night because I assumed it was high. He was in the 300s in the am with no shot in the am. This morning, I had everything ready to feed him, but that little naggy voice in my head said "You better check him before giving him a shot. What if he's low even with 2U". I started trembling the moment the value came up. I almost killed my kitty. I also feel incredibly guilty. At 2 am he was yowling and waking us up (and I had just gone to bed at 1am trying to catch up from all the grading I was supposed to do on Sunday afternoon when I was freaking out about him going hypo. I thought maybe he had pee. He hasn't done this much since he's been on insulin, but before diagnosis he was drinking a ton and peeing in the house if we didn't let him out at 2-3 an. He's been afraid to use the little box ever since he had a cone and was home bound for a month last summer. I've been slowly rehabing him and retraining him on the litter box. I grumbled and got up, gently got him to pee in the litter box, gave him a couple of treats as a reward and went back to sleep. My husband says I snored while he kept getting woken up by Bowie meowing. He was so mad at the cat. Now I realize that he must have crashed really really hard last night and was desperate for food. I should have checked his sugar. I almost did at 1 am, but really needed to get to bed. I don't even want to think about how low he must have gotten. Lesson learned. From now on, no more shots in the dark.

And can someone explain why he is barely eating right now? WTH?!

 

Seems a bit soon, the switch happened that day (Sunday). All week long we've been struggling with getting him to eat in the am. We started mixing in the ff that week. And that day, out of desperation we made the switch. I had discussed it with my vet and she acknowledged that there was a debate in the field about what is better, "junky" (her term not mine) protein rich diet like FF vs. the special high carb high fiber. She said that there were few studies, I agree because I spent a long time looking at the scientific literature and there are few studies. Anyway, I switched to full ff that morning. I am sure that is part of the crash, but maybe there is more going on. I'm all for getting a lower dose in.

 

Scary for sure! Re food: sometimes you have to go by the result a diet produces rather than by the body of evidence behind it. Most FD cats do better on high protein, low carb, wet "junk food" as your vet termed it.

Two units looks like too much now. Have you considered fractional dosing? Do your U40 syringes have half unit marks? You might eventually need to use U100 syringes with half unit marks along with this handy conversion chart to get small dose fractions:
http://www.felinediabetes.com/insulin-conversions.htm

 

I'm still new to this, mine don't have fractional units. I discussed with my vet and at this point we are doing full Unit step downs, but she is thinking we might end up having to go with half units. This was when we were discussing going from 4 to 3U. Now, I don't know where we will end up/be.

 

I contacted the vet. She wants me to stop all insulin for the next few days and then do a new curve.

 

She's probably thinking he's going into remission and wants to see BG data without insulin. Sometimes kitties need to be "handheld" into remission with tiny insulin doses. For some it can mean the difference between a transient remission of one that is sustained.

 

Wow! What an anxiety provoking surprise that morning reading must have been! Glad you caught it and Bowie is Ok. You may be used to him eating more than usual because of his high BGs. Unregulated diabetics can't metabolize their food well so they eat more to get the glucose they need for energy. With Bowie now sitting in normal numbers, as decrease in appetite is not unexpected because he may be getting what he needs out of less food.

 

Glad you caught the low number! Yes, changing diet can make an amazing difference in big levels.

IMHO, cutting insulin out is not necessarily a good plan. If he were mine, I could continue to test, at the usual preshot times and anytime you can get a midcycle number. That way, if he starts to have higher numbers (above 200) you can consider giving him a drop or two of insulin and monitor carefully. My thinking is that this could be a situation after two hypos throwing him into remission (which would be lovely!). Or it could be a situation where he is lower for a cycle or two and then goes back up. If he sits in higher numbers for several days with no insulin, you lose some vital time treating him while he is in regulated numbers. Now that you test, you are in control. You can see exactly what levels he has and decide what to do about them, and know how to bring up a low number if he would have one.

 

I hadn't thought of that Sue and Oliver! Good point.

 

Thanks for the input. I will likely still be testing out of curiosity. If his numbers swing really high, I will contact the vet and let her know. I do worry about him sitting at high numbers. Let's see, with a cat getting not getting insulin, I would think the highest numbers would be 1-2 hours after breakfast.

 

Maybe, maybe not. Sometimes a meal can cause a little pulse of endogenous insulin that might lower the BG.