Info How Low Is Too Low?

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Libby and Lucy, Aug 4, 2015.

  1. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    Recently I’ve seen some statements about low numbers in the Lantus/Levemir group that I believe merit further discussion.

    “We intervene at 50 (some even say 40)”

    If only it was that simple! The saying “every cat is different?” Very true. Also “every cycle is different.” What is the normal range for your cat? What is his onset/nadir? Is he currently surfing or dropping? Is that normal for him? What has he eaten today and when? Is that normal for him? How much food does it take to make him surf? How long does it take for that food to kick in? What if it doesn’t? If you cannot answer all of these questions, then you should think hard about whether it makes sense to wait until the cat is already very low to intervene with food.

    For two of my three diabetic cats, that advice could have been very dangerous and possibly fatal. For example, if I saw Jazzy dropping fast, I knew it took a long time and a LOT of food to get her leveled out. If I waited until 50 to give a teaspoon or two of high carb, I don't think I would have been able to turn her around in time (and Jazzy was a GREAT eater, no worries about whether the food would go in). Putting on the brakes for her required a whole can of food (a 5.5 ounce can). She wasn't interested in being finessed! I thought it was because she was on a higher dose, and maybe it was, but then I saw the same thing with Kris, who was only 7 pounds and on a much lower dose. In both cases, if they were dropping and hit 100 I would start feeding high carb – not to try to prevent a reduction, but to TRY to get ahead of them so they wouldn’t crash. Kris had a pretty good bounce mechanism (not as good as Lucy's) so chances are he would have been ok, but I didn't trust Jazzy to bounce.

    “Symptomatic hypos are rare (or don’t occur) above 30”

    This statement needs to be thrown out with the bath water. First, I’ve seen cats that displayed hypo symptoms in the 60s. It’s not the norm, but it does happen. 40s and 50s too. Know thy cat. Second, who cares? Just because a hypo doesn’t show symptoms does not mean it’s safe. Do you really want to flirt with hypo? There was a great link on the old board (now lost) that explained the brain damage that can occur even before symptoms appear. DO NOT become complacent about low numbers, and do not let anyone tell you to be casual about them.

    “So What SHOULD I do?”

    Feeding the Curve seems to be a lost art. For Lucy, who responded a little more typically, finesse was more possible. We used to say “teach them how to surf.” If your cat is dropping into green and that’s new for him, or if he typically bounces to the moon as soon as he sees green, try feeding him a little food to see if you can get him to stop dropping and start surfing. For example, maybe your cat is dropping, and you get an 80 at +4 and you like that number. Wouldn’t it be great if he can stay there instead of either plunging or bouncing? Maybe he can. Give him a couple of teaspoons of low carb and retest in 30 minutes to see if maybe that got him to stay in the 80 range. If he’s still dropping, maybe try a little higher carb to see if that works. You want to “bump him onto the surfboard” and see if you can get him to stay in a nice range. Most of the time this will not work in the beginning, but keep at it. One day you will notice that your cat DOES surf. He might surf for just an hour before bouncing, but that’s progress! Next time maybe it will be 2 hours, or 4, then one day maybe he’ll just stay on that surfboard forever. Lucy did.

    “What About Feeding to Prevent a Reduction?”

    This is not what I’m talking about here! Instead, you are feeding proactively to try to get him to surf in nice numbers. There’s a big difference. There are people who do feed to prevent reductions, and there are reasons for it, but that is an advanced technique that is not necessary for very many cats.


    Now you are saying “obviously she is too much of a scaredy cat to do Tight Regulation, we NEED low numbers.” No, we don’t. We need the cat to be in the pancreas healing range. 60-90 is a good target for most cats. The guidelines about dose reductions? It is not our GOAL to get below 50 or 40. That is a safety measure – we want to prevent that range, so if the cat hits that range we need to get them out of it and reduce the dose so they don’t do it again. And if they DO do it again, we need to get them out of it and reduce the dose so they don’t do it again. And so on.


    More food for thought – “hypo unawareness”


    This recent study discusses, among other things, something that we have observed here for years: “… episodes of moderate hypoglycemia are not without clinical consequences. Recurrent episodes of moderate hypoglycemia can lead to decreased sympathoadrenal responses and decreased awareness of hypoglycemia, collectively termed hypoglycemia associated autonomic failure (HAAF)7, which leads to an increased risk of more frequent and more severe episodes of hypoglycemia.”

    We "teach" our cats not to bounce from low numbers by repeatedly exposing them to normal/lowish numbers. It's part of tight regulation, but it does carry a lot of responsibility.

    How many times have people here commented that their cat was in the 20s or 30s and didn’t look for food? Lucy did that. Is that ok? Obviously Lucy survived the 30s, and most cats do. But would she have been just as unaware in the 20s? Or teens? What if she went low at night and didn’t wake up? I don’t know. Personally I feel that it if I push her into tightly regulated numbers that could result in hypo, it is my responsibility to be sure she stays safe. If she isn’t noticing her low numbers, then I have to notice them for her. If I cannot test 24/7 (and I don’t know about you, but I can’t stay awake 24/7 forever), then I need to prevent hypos rather than reacting to them.

    Bottom line: “How Low is Too Low” is very situational and there is no single answer. All that data you have been gathering – use it! Know your cat, then do what is right for him or her. There are others here who can give advice based on their own experience or their observations, but YOU know your cat better than anyone else. Trust yourself, trust your data, and don’t become complacent.
     
    Last edited: Aug 4, 2015
    Reason for edit: spelling
  2. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    For safety's sake... this needed to be said.
    Thank you, Libby.
     
  3. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Thank you, Libby. Very good info. Your last section reinforces what Dr. Richard Nelson told me about low numbers. He was more concerned about the damage low numbers do than high numbers (occasional ones, that is). I hope everyone, especially the newbies, reads this and takes it to heart.
     
    Critter Mom likes this.
  4. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    new members and older ones both. Sometimes I think those of us who have been here the longest can be the most complacent.
     
    Amina&M'row and Critter Mom like this.
  5. CarolynE

    CarolynE Member

    Joined:
    Jul 21, 2015
    Thanks Libby.
    I am VERY new to this - today is Martian's third day on insulin, and first day of home testing (the vet kept him in for testing for the first two days).
    He dropped pretty low both days at the vet, with nadir around 9 - 10 hours. So when I tested him at +4 today and he was 68 I started worrying. Luckily he had just taken himself for a good feed and when I tested him at +5 he was back up to 99. I don't have enough data to really know his reactions yet, but your post makes me happier that I went with my gut instinct on this one.
    I'll keep checking on him during the rest of the afternoon, and I'll probably be asking for advice on whether or not/how much to shoot tonight and in the morning.

    Carolyn
     
  6. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Good information. Thanks for the link to the summary of recent research.
     
  7. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Thank you so much for this post. I have been doing reading recently on hypos and your posting reinforces the fact that a cat can be experiencing hypo effects without showing outward signs. The body can be "responding" to a perceived hypo even though the numbers do not justify a hypo alert. Another good article:

    http://clinical.diabetesjournals.org/content/24/3/115.full

    I personally am more concerned about continuous "hypoish" numbers than about periods of higher numbers. Hypos can kill quickly...high numbers slowly effect the body and organs over time. Regular testing and patience are the best approach IMHO

    Another good article although this one relates more to type 1 diabetes:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279554/
     
  8. Libby and Lucy

    Libby and Lucy Senior Member Moderator

    Joined:
    Dec 28, 2009
    thanks for the additional links!

    One more thing to add for those looking at my spreadsheets. Lucy did hit 30s somewhat frequently when she was on insulin, especially when she was running down the dosing ladder. I did my darndest to prevent it, but it does happen and sometimes she was pretty hard to bring up. I knew I was in control and I stayed with her (control is the key - you do not want 30s to accidentally turn into 20s just because you're not paying attention). Now that she has been off insulin for over 6 years, I know that her normal range off insulin is in the 30s and 40s with my meter. That's not the norm and I wouldn't try to excuse too-low numbers that way unless you happened to test your cat enough before he was on insulin to know what his normal non-diabetic range was. ;) If she ever goes back on insulin, I'm still going to try to keep her above 40-50 because of the control factor. I believe (and have seen over and over) that tight regulation and remission can be achieved without pushing the boundaries too far.
     
  9. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Excellent post, Libby. I would really like to see this as a forum sticky.

    I know that there is some debate about equivalence of reference ranges between human and Alphatrak/other pet-calibrated meters and that more definitive reference ranges for these meters are currently being sought from Dr Rand. On behalf of myself and other pet-calibrated meter users I'd like to put forward a request that somewhere on this thread there could be included some appropriate 'interim' reference range numbers they could use in order to make the opening post more easy to relate to their glucometers (together with any disclaimers deemed appropriate).

    ----

    Libby and @Tuxedo Mom - Thank you both for the valuable links.
    .
     
    Last edited: Aug 5, 2015
    Capoo likes this.
  10. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014

    I am quite interested in what Dr Rand has to say. The study gave some guidelines for the variance but mainly at the low end of the readings. I have a tab on my spreadsheet that shows same blood drop comparisons between the AT2 and FS Lite meter. I had more earlier but did not keep a record. Although there is of course a +/- allowable error range, there seems to be a basic % pattern overall. For people like myself, using a pet meter makes it very hard to request advise on doses etc since the majority of people here use a human meter. I choose a "higher" number as my "hypo alert" than many others would and do not aim for as low a number to surf at.
     
  11. lovey11

    lovey11 Well-Known Member

    Joined:
    Aug 6, 2013
    I agree this would be a great addition to the sticky notes. It gives a good perspective to keep our pets safe and to understand our pets responses.
     
  12. Patricia & Noodle

    Patricia & Noodle Well-Known Member

    Joined:
    Jan 21, 2015
    Thanks for this information, Lucy! It's really helpful, especially for those of us with cats that have perfected the swan dive. I've found feeding the curve, even if I have to use some HC, (I use honey thanks to a suggestion from @Bron and Sheba and @Sienne and Gabby ) has helped manage the severe drops so much. If I waited to feed until she was under 50, she'd be bouncing up and down the dosing scale with no "good dose" in sight.
     
  13. Shiloh & Rhonda (GA)

    Shiloh & Rhonda (GA) Well-Known Member

    Joined:
    May 9, 2015
    Thanks Libby. This actually hit home for me.
     
  14. Marycatmom

    Marycatmom Well-Known Member

    Joined:
    Oct 24, 2014
    I, too, would like to see this become a sticky. So much helpful information!
     
    Critter Mom likes this.
  15. Marje and Gracie

    Marje and Gracie Well-Known Member

    Joined:
    May 30, 2010
  16. Paula

    Paula Well-Known Member

    Joined:
    Apr 19, 2014
    Bump
     
  17. Gill & George

    Gill & George Well-Known Member

    Joined:
    Oct 27, 2015
    Love the explanation Libby, haven't seen that one before Marje thanks for the Bump.
     
  18. LemmiwinksMommy

    LemmiwinksMommy Member

    Joined:
    Apr 27, 2016
    Thank you so much for this!!! I am so new at all this. My Lemmiwinks just decided that he was gonna go from the 200's to the 80's. I do understand that we are shooting for those good numbers, but was also a little nervous of what to do with them. I want to do whatever I can to help him. This was just what I needed....THANK YOU! :bighug:
     
  19. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
  20. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
  21. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    Thanks for bumping this Leslie. People REALLY need to read this over and over and over!!
     
  22. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
    Agree, all of these make more sense with more experience. I reread them constantly!:bighug:
     
  23. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
    I think this info post is where I learned to feed the curve to keep Gussie surfing, to keep him in green to let his pancreas heal, why what you guys were telling me made sense.
     
    Tuxedo Mom likes this.
  24. Tuxedo Mom

    Tuxedo Mom Well-Known Member

    Joined:
    Dec 2, 2014
    So important for people to know that numbers are not written in stone. ECID....(Every Cat is Different) Know your cat and use the protocols as a guideline!!
     
    Photorecon and Gussie's mom (GA) like this.
  25. Photorecon

    Photorecon Well-Known Member

    Joined:
    Apr 27, 2016
    This comes at the right time, just when I was questioning stopping feeding between cycles as it doesn't
    seem to have any effect. Might be a life saver one day.

    Extremely interesting, thanks.

    .
     
    Gussie's mom (GA) likes this.
  26. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Bump for newer members! :)
     
  27. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
    This should be required reading..thank you! And thank you!
     
    Jill & Alex (GA) likes this.
  28. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
    Adding another bump with thanks to @Bobbie And Bubba for reminding me to read it again! Gussie's hypo or at least consensus was pretty sure it was was one of the ones in higher numbers than expected...
    Thanks again..bumpity bump
     
    Bobbie And Bubba likes this.
  29. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
  30. Kathy and TiTi

    Kathy and TiTi Well-Known Member

    Joined:
    Feb 12, 2016
    For months now, I've cast a baleful eye at the aggressive pushes downward that I've sometimes seen. I've learned that as long as TiTi is in the 70-123 range, she's perky, healthy, and bright eyed. To me that seems good. I think, well, I hope that she's healing in this range.
    I didn't know until I read this that 50 0r even 60 can be a hypo. However, I've never liked it when TiTI hits low 60s to 50s, because in the early stages of her cycle, she can drop quickly, especially at night, so I got into the habit of feeding her a tsp or two of LC every few hours, and always after testing. Seems to keep her smooth. At night I give her at least 2 TBS of food before I hit the sack - just in case.
     
  31. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
  32. Kathy and TiTi

    Kathy and TiTi Well-Known Member

    Joined:
    Feb 12, 2016
  33. Marlena

    Marlena Well-Known Member

    Joined:
    Nov 25, 2015
    Thank you Libby for a very informative article!:cat::cat::cat:
     
  34. Gussie's mom (GA)

    Gussie's mom (GA) Well-Known Member

    Joined:
    Jun 25, 2016
  35. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Bumping per request.
     
    Tanya and Ducia likes this.
  36. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
  37. Krystina & Nelli

    Krystina & Nelli Well-Known Member

    Joined:
    Jul 4, 2018
    Bump
     
  38. Photorecon

    Photorecon Well-Known Member

    Joined:
    Apr 27, 2016
    Hi everyone,

    Not that long ago when Small Kitty was taken care of by a petsitter I came back and sugar kevel was at 36. He was in the kitchen mot moving that much.. He was stii breathing had a normal appart from staying where he was. As I didnt know if he was still going down I gave him some maple sirop. Little after he was ffime if my memory is fine.

    Each time Small Kitty goes down his sugar level goes crazy (end up being purple) and it takes several days to bring him back down. That's the price to pay of a dose that is too high.

    Hope this hells others, have a good one

    Seb
     
    Tanya and Ducia likes this.
  39. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Good to see this again!
     
  40. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    The OP in this thread wrote this post for those practicing tight regulation. It came about because there was a growing trend among those practicing Tight Regulation to become nonchalant about low numbers... numbers mostly in the 20s, 30s, and 40s. Since their cats weren't showing symptoms, they were allowing the cat to ride in those low numbers without any apparent concern or worry because they did not want to 'shorten duration' or mistakenly think they would 'contribute to the bounce' by intervening with high carb food or syrup.

    Currently, those in other insulin groups do not practice tight regulation like you've been doing nor do they 'teach a cat to surf' in low numbers. If the post was appropriate/applicable for the general Health Forum, Moderators would have made the decision to post on Health, the other ISGs, and/or in the Health Links/FAQs Forum. We did discuss at the time, but didn't want to confuse those using other insulins with TR practices, or worse yet... let them think mid-greens are ok/the goal when using all insulins. :confused:
     
  41. Ti-Mousse

    Ti-Mousse Well-Known Member

    Joined:
    Dec 2, 2018
  42. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    (bump)
    I knew right away that such valuable post could not have been just discarded even before I spotted the yellow Info sticker at the top. If I had any knowledge about other insulins I would (probably) have figured it out myself but my mind is so very Lantus.
    Now, after you pointed it out, I can certainly appreciate the wisdom behind the decision not to post. I personally was very taken by the “Hypo Unawareness” expression -it fits Ducia’s antics to the letter.

    My post in Health already sank to the bottom and should not cause much confusion. Although what I hoped it had done is helped our newer members to overcome their fear of home testing and, more specifically, to circumvent their “vets” order not to test at home. “Vets” have not being helpful in that regard at all
    I hope no one died. Was it really worth the risk as in any of them got OTJ? Ducia started to have violent seizures at BG 33/29, and was none responsive/comatose at BG 22 when we got to the ER; she had encephalopathy (of the unknown degree) and her vision was temporarily gone. Was any other damage done? IDK. Do I want to know at which low point exactly she crashes or brain damage become apparent? I think not.

    I want no cat “to swim with the sharks” to prevent that cat from ending up “sleeping with fishes”. [Sicilian expression from The Godfather meaning “dead”]. No do I want anyone to develop HAAF. It sounds like an expressway to Hypo.

    I appreciate the re-post and especially the talk, thank you
    @Jill & Alex (GA)
     
    Bobbie And Bubba likes this.
  43. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Tanya, I so appreciate how this info sticky got your attention. I remember the hypo day with Ducia like it was yesterday. It was probably the most stressful day on this forum that I ever went through. Ugh. Thank you God that there was a happy outcome for you and Ducia.
     
    Tanya and Ducia likes this.
  44. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    Bobbie, :bighug::bighug::bighug:
    I forgot (as if) the details but what I won't ever forget is your and all of the gals help and sticking with us till the latest whilst being almost sick to your stomach
    but especially (please forgive my awkward attempts at humour, I mean to make a joke) that rectum syringe, lol, I told you before that it is how she survived the trip to ER, the doc listened so attentively when I told her what I did and I believe since that she used the tip for her patients.

    I am so very sorry about Forrest departing, Bobbie.
    :bighug:
     
    Bobbie And Bubba likes this.
  45. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    :bighug:
     
  46. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    It was the first and only time that I instructed someone to use a feeding syringe with Karo syrup or honey and shoot into the rectum because the kitty was in seizure with it's mouth clenched tight. I hope I never have to again, but I will do so if necessary. It was lucky for you that Ducia had been discharged from the hospital from DKA and you had feeding syringes on hand.
     
    Tanya and Ducia likes this.
  47. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

    Joined:
    Jun 15, 2015
    Hmmm, feeding syringes...that might be something that everyone should have in their hypo kits.
     
    Crista & Ming likes this.
  48. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    a must to have item, for sure.
    we were even luckier - DCIN :bighug::bighug: paid for the E-Tube.
     
    Bobbie And Bubba likes this.
  49. Amina&M'row

    Amina&M'row Member

    Joined:
    Jan 2, 2019
    Great, great article; I downloaded it so I have it at hand. Like many kitties, M'row is asymptomatic at scary low numbers; important to keep this in mind and hometest. I do before every shot, and am not scared to skip the shot if needed. The first time he went low he wound up just about covered with Karo, LOL, but came out fine.
     
    Tanya and Ducia likes this.

Share This Page