How low do you allow blood sugar readings before you compromise your insulin dose?

So I’m taking Leos blood glucose curve today for the first time.. I know I should have so long ago, I just hate pricking him more than twice a day
This morning he read 107. I gave him 1.25u of novalin n, slightly less than his usual dose... I’m now kicking myself realizing 107 is pretty low for his morning bg. When do you decide to lessen or skip the dose, what number is too low? I read not to dose novalin if he reads under 180 but that just confused me further because he is usually under 180.
Three hours in and he is reading 58 (human meter) which makes me nervous! Should I feed him a bit or continue to check the numbers and not compromise the curve? I would really like to know how Novalin really works, but low readings make me nervous as heck :/ I decided to stay home today so I could keep an eye on him just in case!

 

Update: after 20 mins I took his reading... 65. I tried one more time to see if he really was going up and the meter indicated that heeeee wasn’t! 57 the second time. I know these aren’t terrible numbers but I fed him a tiny bit so it compromises the accuracy of my curve. Oh well, I guess now I know to be careful with novalin.. his bg dropped by 51 in two hours!

 

Everything you want to know is in here:
http://www.felinediabetes.com/FDMB/threads/beginners-guide-to-novolin-humulin-nph.186097/

Read it over and come back here with your questions.

 

Never sacrifice health for a curve. Curves can be redone but there's only one Leo.
Noah is unregulated and his PM readings are always lower than AM. It's a long story why I cannot check him throughout the night so I generally give him a 2/3 dose at night. I don't use Novalin so hopefully you'll get some better advice soon.

 

Thanks so much for the link regarding Novalin! See now I DO have questions... this page says the general no shoot threshold is 250-300... Leo has been under by a long shot, ever since I took him home from the vet. (You can see in my chart.. his evening and morning doses tend to both hover around 140.) he is currently on 1-1.25u of novalin... should I withhold insulin tonight if his numbers are still within 1-200? I cannot believe how badly this could have gone if I had gone to my studio all day after dropping his bc to 57... after some food he’s up around 65.. phew!

 

Update: I do not trust my meter at all... about a half hour ago and then again just now I texted him twice. Both times he read 65 the first time, and 57 the second time. And I fed him after I checked him a half hour ago! Is the ReliOn Premeir Voice an adequate meter or should I invest more money in a better one? I’m in college so I’m doing the betus on a pretty tight budget right now.. Walmart brand has been a lifesaver

 

Hopefully, more Novalin people come on soon for dose advice-those numbers would make me nervous too! The good news is that you are home testing and can get this figured out. You are testing him first before feeding and giving the shot, right? On your spreadsheet where you wrote morning and evening is where you should put his pre-shot BG numbers. Then the + 1 column would be for tests done one hour after the shot. I know you have more important things to worry about currently with keeping him safe but just wanted to point that out

 

I use Relion Confirm (also very budget friendly) and have pretty consistent results. I think most meters have a bit of a buffer (I think 20%) but I would assume it's pretty accurate. How long has it been since you've given him his shot?

 

He gets his shots at 12 and 12, so about 4 and a half hours. My curve was unsuccessful in that I did not determine his nadir, but I did determine that I should never shoot full dose when he’s that low!

 

Thanks so much for the advice! Yes, I generally check him right before administering insulin. Usually he reads somewhere from 130-140, I give him 1-1.5u depending on what my gut is telling me, and go to the studio. 12 hours later when I come home he’s his happy peppy self, back up at 140. I think I’m going to skip his dose tonight and see where he’s at tomorrow, as even just 1u has his preshot at 120-130 these days.

 

I wouldn't call it unsuccessful, you are still getting some mid-day numbers which is important. It looks like the nadir for Novalin can be between 2-6 hours so if you are only at +4.5 currently, I'd keep testing for at least a few more hours to see where he ends up. You're doing a great job of figuring this all out!

 

Thank you so much for the advice gosh I say this a lot on here but y’all are really helping so much with this, I’ve been so on my own here up until now and I can’t believe how much really important info I wasn’t aware of! And the support through this is very reassuring

 

I feel the same way! This is a pretty unique site in a way that we are all learning and teaching at the very same time. I am forever grateful for FDMB!

 

Yes! There’s such a plethora of info and we all benefit from learning about each others experiences. Also side note, his bg was 89 when I tested him about 10 minutes ago, so I’m definitely feeling relief right now. Thanks so much for your help!

 

I'm relieved too! Based on that it looks like his nadir is around +3 but you'd need more mid-day numbers to really be sure. It's so exciting that he seems on his way to remission!

 

Yes very exciting! I’m going to get a good and thorough curve on a day where his numbers are higher just to get an idea

 

I'd say that so far you've been VERY lucky. Here's what the Novolin guide says:

Q: It’s time for my cat’s shot but the BG is a little too low. What now?
If your cat’s BG is a bit below 250 mg/dL [13.8 mmol/L] on a human meter you can consider ‘stalling’.
‘Stalling’ is waiting - without feeding your cat - for 20+ minutes, then retesting to see if the BG has risen to a suitable level.
You are looking for a number that is rising, not falling, and is up to at least 250 mg/dL [13.8 mmol/L] on a human meter.

If using a pet meter, such as Alphatrak2, you may want to raise the number above 250 mg/dL [13.8 mmol/L] to give an added margin of safety. (If in doubt seek advice from your vet.)

If you have time, you can repeat the process to see if the cat’s BG reaches a number you can shoot. But you may not want to continue more than an hour, as this may throw your schedule out (and your cat will become increasingly hungry!). If in doubt, skip the shot.

If your cat’s pre-shot level is significantly lower than usual, post on the forum for advice about how to proceed.

Note: If your cat has had ketones or DKA (Diabetic Ketoacidosis) then DO please post on the forum for further advice if you are considering skipping a shot, or raising your ‘no shoot’ threshold.


Q: How low should I let my cat’s BG drop on N/NPH?
It's advisable to not let the BG drop lower than 100 - 120 mg/dL [5.6 - 6.7 mmol], as measured on a human meter, at the peak of the cycle.
If you are using a pet meter you may want to keep the nadir higher than is suggested for human meters. (If in doubt seek advice from your vet.)
N/NPH can drop the BG very sharply indeed. Trying not to let the BG drop below these levels helps to give a buffer of safety.

If you get a BG of 100 - 120 mg/dL [5.6 - 6.7 mmol] on a human meter, and there is still some time to go until the peak of the cycle you may need to take action to ensure that the BG doesn’t drop much lower, and monitor closely until past the peak of the cycle.
Note: If you are using a pet meter you may need to keep the nadir higher than is suggested for human meters. (If in doubt seek advice from your vet.)

These comments are meant to be helpful, not to chastise:

• so far the only pre shot that was (almost) high enough to give Novolin was the morning of 26 March
• you're seeing only half the picture by not testing before the evening shot and many cats drop lower at night
• you don't know how low he might have gone on all the days you have no data after the AM pre shot test - it could have been very low but he (luckily) didn't lapse into a symptomatic hypo
• today's data tells you the 1.25 u dose is too high.

Here's what I suggest for Leo's safety:

1. drop his dose immediately to 0.5 u
2. keep that dose AM and PM for the next few days
3. do a full curve on that dose one day this weekend
4. start following our recommended testing routine as described below.

BG Testing routine:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

 

I agree with Kris: time to reduce that dose! Leo's numbers look amaaaaaaazing, but there isn't nearly enough of a safety buffer for the dose of Novalin he's getting. The thing about dosing too much is that a cat's body has defense mechanisms for preventing hypoglycemia, but they don't work perfectly and they don't work forever, so you don't want to tempt fate. Looking at Leo's numbers right now, I don't think he likely needs that much insulin to be in "good" numbers, in any case.

Side note: if you're worried about your meter, you can always test yourself or a non-diabetic ("civvie") cat! They also make "control solutions" for testing strips and meters, if you can find them for your meter.

 

That's perfectly normal....even if you could test the exact same drop of blood with the exact same meter at the exact same time, you could get results that vary by up to 20%

The FDA only requires that "personal testing devices" get within 20% of the number you'd get on professional lab equipment.....so a 90 could be anywhere from 72 to 108.....and a 300 could be anything from 240 to 360

What we look for more than specific numbers are "trends"....is the current dose getting them where we want them?

All that being said, I totally agree with Kris too....time to lower that dose and see how he does! It's a good thing you were testing today and could keep him safe.

That steep dive so early is one of the reasons we don't really like using Novolin in cats. It tends to take them low quickly and then wear off too soon.

Good job today though!!

 

Wow thank you guys all so much! I’m definitely going to keep all this in mind and get on it right away I too am sooo glad that I was home today to monitor him. Im now realizing his numbers for the past few weeks have probably been pretty low during the day while I’m out. Scary as heck I’m lowering his dose ASAP! Yay Betus

 

I've caught up on your previous thread and I just wanted to tell you that you have done a stellar job of educating yourself and taking things into your hands! Kris has given you great advice, I hope all goes well from here.

 

Wow 120 this morning after no insulin last night

 

:’) no insulin for him as of right now, these levels are beautiful! Kris suggested .5u, Im just concerned because if his levels are this low should I shoot at all? This morning I followed my gut which said hell no!

 

Thank you so much!

 

Remind me, human meter or pet meter?

 

Oops sorry the answer was in your signature.

Even with a pet meter I’d try not shooting given the values you’re reading and your insulin is novolin. See how that goes? If numbers rise than maybe 0.25 next cycle

 

Thanks, that’s exactly what I was thinking! Even a few weeks ago I skipped a few shots and he was around 140.. he used to be at 7u! Crossing my fingers and keeping and eagle eye on his numbers right now!

 

Good idea to skip this AM! Watch his numbers and maybe try a tiny dose if they start to rise.

 

Good advice! He’s at 136 about 4 hours since eating this morning and he’s chirpy and lovey as usual!

 

Honestly, if he's staying under 150 with no insulin... keep watching, but this is looking good!

 

143 this morning, 48 hours after his last dose of insulin! I’m so proud of my bunny