? Low numbers- Need help

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Missy, Feb 21, 2016.

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  1. Missy

    Missy Member

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    Sumo has been doing very good. He is no longer ravenous and has gained half a pound. He also started playing alot. The past two weeks he has had a complete diet change to soft food and is doing exercise plus is getting a very big dose of tlc.
    Over the past week and a half I have seen the numbers go down. From 25mmol+ it has gone down pretty fast. Testing every couple of days:
    23
    20
    8!
    7.5
    And today 5. I'm getting a bit concerned for hypo. But he seems very happy.
    Ok I know no one here really like glyburide but it's all I can do for now. He is on a small dose of it, 0.625mg per day. Should I give him his pill tonight? My vet is closed on the weekends and I don't know what to do. I know not many people here have experience with glyburide but maybe someone can give me some info.
    Thank you
     
  2. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014
    I am not familiar with glyburide. However you have changed the diet to all wet food, which can lower glucose levels just from the change. Since you are only monitoring sporadically you do not have any long term data as to how low the medications can take Sumo. Glucose levels never stay the same all the time. They fluctuate normally throughout the day. Sumo could have even gone lower than the 5 mmol/L (90 US) reading you got today. With numbers that low and without knowing just how much the glyburide affects his levels, if it were my kitty I would not give the pill and talk with the vet tomorrow.

    Even though you are not using insulin it would be wise to do more testing than every few days. Glyburide will still lower the glucose levels and hypos can occur with oral medications as well as with insulin. Many cats will not always show the initial signs of a hypo episode, but it can be serious if not caught and treated. You could also do some more monitoring since treatment dosing is never based on just one reading done at the vet. Usually a curve is done to see what the responses are to insulin and it would make sense to do the same for glyburide.

    If you want to get more people responding, you could add the "?" icon to your title.
     
    Last edited: Feb 21, 2016
  3. Missy

    Missy Member

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    Feb 3, 2016
    Thanks for the input. We are trying hard to test him more but he is a difficult little bugger. He is getting better but it's not his idea of fun. I will test him again today before the pill and if it is that low I don't think I will give it. We will be going to the vet as soon as possible. I'm calling them right when they open tommorow.
     
  4. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    In people glyburide has been shown to cause more severe hypoglycemia than other similar oral medications and can be harder to reverse a hypo when it happens. This is study done on people but the same principles will apply with kitties:

    http://www.ncbi.nlm.nih.gov/pubmed/16324923

    The biggest problem with not having more data is that you really don't know how low the glyburide can take him or how long the effects last. Although the mechanics of glyburide are different that insulin, the end result is that both lower the glucose levels. When unsure whether it is safe to give the glyburide it is better to err on the side of caution and wait until you can discuss the readings you have been getting with your vet. As well as I said previously simply by removing dry food and high carb food, glucose levels in some cats can drop quite a bit.

    Most kitties are not fond of having their ears poked and prodded, but with using a regular routine, in a calm matter and of course some kitty scritches and treats most cats will learn to accept testing as a normal part of their day. When I first started testing my kitty was howling, I was in tears and I just knew it would never work. After a week or so with LOTS of testing ( I go a little overboard :) ) he became much better at test times. Now he just walks to his test area and sits on his mat to wait. He is VERY food oriented so that definitely helped with getting him (and me) comfortable with tests.
     
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  5. Gill & George

    Gill & George Well-Known Member

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    Oct 27, 2015
    I would also be concerned about how low the glyburide might be taking him.

    Better too high for a day than too low for a moment, especially as you are still finding your feet with the testing (that will get easier)

    Good luck at the vets tomorrow.
     
  6. Missy

    Missy Member

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    Feb 3, 2016
    Sometimes he is very open to it and sometime not. I also have very shaky hands and it is not easy for me to do this. If I try to do a precise thing with my hands they start shaking and the cat thinks I am nervous. Plus I end up jabbing him in the wrong place a few times. I will try to step up the testing. Can't wait to talk to the vet tommorow. Will test later and if it is still around these numbers no pill I am not taking that chance. Thanks all for the info.
     
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  7. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Learning to test is never easy especially if your hands are unsteady.

    I don't know exactly what number would be a "no pill" number but from the numbers you posted Sumo seems to be dropping a fair bit...whether that is from the food change, the extra exercise, the glyburide or a combination of any/all of these. I forgot to ask..what brand of meter are you using for testing...is it a pet specific meter or a human meter? And about how long after taking the glyburide were you doing the tests?

    I am just concerned about the dropping numbers and trying to figure out if it is safe to give the pill. As Andy said "Better too high for a day than too low for a moment".
     
  8. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    You have already got some great advice and I'm with Mary Ann. If I were you, I would not risk giving the pill tonight no matter what reading you get. Diet and the glyburide have made a big difference in his BG readings and until you can test more, you don't know how low he might be going. Not to scare you but one episode of going too low is a lot more dangerous than him being high for a day. My advice would be to test tonight and see where his BG is but don't give the pill and speak with the vet tomorrow.
     
  9. Missy

    Missy Member

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    Feb 3, 2016
    @Tuxedo Mom Sorry not to have given more details, bit of a brain fog today. The numbers on top are in the morning before eating. Here is my full testing records. First number is morning without food and second number is about 4-hours after glyburide in evening if I managed it. Im using a one touch ultra 2.
    28.2- 31
    23.3
    24.2-28
    23.2-25
    20.4
    8.4-9.2
    7.9-9
    6.1-5
    This is the first time evening numbers were lower than morning. This was for yesterday. Did not manage to do a test this morning.
     
  10. Missy

    Missy Member

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    Feb 3, 2016
    Thank you! I never thought they would drop this fast. The impression I was getting from the vet when we first brought him in is that he was too far gone and probably would not bounce back. I am shocked it went down so much and I wish I would have tested more to know how much impact the pill was doing. Going now to try to test and I hope I get something because these numbers are making me nervous. I am not going to give the pill unless I get a reading and it is high. Even then I'm not sure, wish the vet was open on the weekend.
     
  11. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014
    Thank you for the information. Looking at how much Sumo has been coming down I would NOT give the glyburide tonight no matter what the number is. From the tests that you have done you can see how much he has come down and at this point there is no way of knowing what a dose could do. Higher numbers are not great, but a hypo episode can be deadly or at the least extremely expensive if he has to go to the ER. Probably in the range of $1000 +. As MrWorfMen's Mom said in her post " one episode of going too low is a lot more dangerous than him being high for a day".
     
  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    It looks like the glyburide has done exactly what it is meant to do and that is to push the pancreas to put out more insulin. The problem is that the drug will continue to act even if the other hormones in Sumo's body say it's time to shut down the insulin being pumped out and there is no way to shut the drug off. All you can do if he goes too low is treat symptoms and try to keep his BG up! Your cat's natural defences against hypoglycemia are not going to work normally with the drug in his system! This is totally different than insulin shots! That is why we're advising you to err on the side of caution and NOT give the pill NO MATTER WHAT HIS READING tonight.
     
  13. Missy

    Missy Member

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    Feb 3, 2016
    @MrWorfMen's Mom Oh my I managed to sneek up on him while he was sleeping( he usually gets up and follows me around if I'm doing something) Testing took like 20 seconds! If only it was always this easy. The number was 12.9. Now I am more torn on what to do. This could be attributed to a new flavor of food we are trying. His usual rounds out to about 2-3 percent dry matter carbs but this new one is like 11 ish. Still low carb but not as much as the other flavor. I mix the two together because he was snubbing the other flavor a bit, bored I guess. Should I give the pill now with this new info? So much to take into consideration this is driving me nuts. Still waiting for the as fed number from the food brand so just garanted analysis for now.
    New flavor:
    Crude protein (min.) 10.0%,
    crude fat (min.) 5.0%,
    crude fibre (max.) 1.5%,
    moisture (max.) 78.0%,
    ash (max.) 2.7%,
    taurine (min.) 0.05%
    Old flavor:
    Crude protein (min.) 10.0%,
    crude fat (min.) 6.0%,
    crude fibre (max.) 1.5%,
    moisture (max.) 78.0%,
    ash (max.) 3.7%,
    taurine (min.) 0.05%

    I have other flavors but they fall somewhere between these two. They don't have grains or rice.
     
  14. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Missy, the caveat to all of this is whether the diet, glyburide or a combination of both, have made the huge difference in Sumo's BG numbers. You don't have enough testing to know how low Sumo goes and even with more data , changing diet and administering medication at the same time, leaves this question unanswered. The higher carbs in the different food could very well account for the higher numbers right now. When did he last eat?

    Admittedly I have never used glyburide with a cat, but as a medical professional (human) I think it's a pretty safe bet it's active for 24 hours in your cat since you only give it once daily. If 4 hours after the glyburide the other night Sumo was at 5, he could have gone much lower and into dangerously low numbers overnight but you don't know that. Sumo will be fine at higher numbers for a day. He will NOT be fine if he goes too low overnight while you are catching some ZZZ's and can't help him!

    PLEASE DO NOT CONSIDER GIVING HIS PILL TONIGHT NO MATTER WHAT HIS READING IS. These furry little critters have a nasty habit of having lower BG numbers at night than they do all day! If you still insist on giving the pill if his number is higher, then I very strongly suggest you make sure you get your usual 4 hour test and set your alarm for another test about 6 hours after the pill to determine if he is still dropping or not. This is the only way to make sure Sumo is safe given those drops you have seen to date.

    ETA I don't see a huge difference in those two foods carb wise but that's just with a quick scan of the GA.
     
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  15. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014
    I totally agree with this statement. Missing the pill tonight will not cause any long lasting effects. At the very worst Sumo may have higher numbers temporarily but until the current responses to the glyburide have been studied by your vet the safest approach is no pill.
     
  16. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I agree with the members who suggest that you DO NOT give the glyburide tonight.

    You mention that the 12.9 reading was after you'd given Sumo a higher carb food. That will bump his numbers up but it may not keep them up once the extra carbs 'wear off'. Also, as Linda states above, a great deal - possibly the majority - of cats run lower at night and therefore are at greater risk of hypo during these hours.

    Sumo has shown a very strong response to the change to wet, low carb food. Cats being treated with insulin can also show drops like that as a result of the food changeover, hence the insistence of the likes of Dr Lisa Pierson (author of catinfo.org) about the need to home test right the way through the transition and a bit beyond in order to keep a cat safe and reduce its insulin dose as needed.

    You may notice further improvement in Sumo's BG numbers over the coming week or so as the low carb food really starts to benefit his system so I suggest a very cautious and conservative approach to any BG-lowering treatments at the moment. As Linda says, they don't come with OFF switches.

    For safety reasons, if Sumo were my cat I would wait to speak with the vet before giving any more glyburide. I would also try to get several tests in overnight to see how low Sumo's BG goes in the meantime. It will be very valuable data and will be very helpful in guiding you and your vet to appropriate treatment choices going forward from here.

    Marathon, not sprint. ;)


    Mogs
    .
     
  17. Missy

    Missy Member

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    Feb 3, 2016
    @MrWorfMen's Mom @Critter Mom @Tuxedo Mom Thank you so much for your help. I don't know what I would do without you guys. Even if I'm using a non recomended medication you guys have all been so helpful. I am not giving his pill tonight and I will call the vet as soon as possible. She will of course say my readings are innacurate because I am not using an alpha trak but I hope she will humor me.
    Sumo eats his breakfast at around 2pm(we work nights) he gets his pill around 5pm followed by a snack 30 minutes later. At around 2-3am he gets another meal. There is always some left over from feedings and he does munch on it later on. I do have 4 cats and some will not eat when others are eating so I leave some out. So it is not portioned meal but more of a free feed. I am trying to get everyone used to timed feedings but 15 years of habits die hard. Also I am afraid he will be hungry and he really needs to gain a bit of weight(never thought I would say that about this cat) He seems to have a panic attack when he cannot see food. Even if he does not eat it he really freaks out if there is none(crying and panting). He used to be a nibbler, spending all day next to the food eating.
    The other cats BG has not gone up from the new food. Misty who was at 18 when fed dry has now been consistent at 4 to 6 at various times during the day. I think I might have changed foods just in time for this girl. Plus she is losing weight slowly. My goal is to have her slim and trim.
    Thanks again everyone for helping me today.
     
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  18. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I am so relieved to hear you decided not to give the glyburide tonight. When you talk to your vet, make sure she knows that human meters read lower than the AT however, the difference between their numbers is far less in the low ranges and at 5 on a human meter, Sumo would be considered to be in an acceptable BG range. Also, I'd make sure your vet provides you with some guidelines as to how and when it is safe to give the glyburide. For example, at what BG number should you withhold the pill assuming you test right before administering the medication? That way, you can test and more confidently make a decision when the vet is not available for counsel. I would also question whether it might be a good idea to give him a few days with diet alone to see if that alone has brought his numbers down significantly. If diet has had a profound effect alone, perhaps the dose of glyburide needs to be lowered! Please keep us posted!
     
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  19. Jeanne & Dottie

    Jeanne & Dottie Member

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    If you have a multiple cat household, there is always competition for food, even though you might not see it. "Survival of the fittest", and in their little kitty minds, he who eats last, usually comes up short. Some cats are more anxious about this than others, and if you free feed, this anxiety can lead to overeating and/or pestering for food, because cats will all try to assure they get their share of the pie. If you plan to dry feed at all, make sure they can't see the bottom of the food dish because that's a Red Alert for "Food Running Out". Make sure your dish is an inch deep, and the bottom of the dish won't appear as readily, causing your cats to believe the food is about to go POOF.
     
  20. Missy

    Missy Member

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    Feb 3, 2016
    I'm so happy I talked to you guys yesterday and I am now positive we averted a disaster. Did not give the pill. After the 12.9 reading yesterday night it started falling slowly. 9.9 then 8 and after that went to bed. This morning before food it was at 5.5! He would have for sure gone hypo with the pill. On the other hand the last test was a bit weird. Did not get a nice little bubble of blood because as I was poking him he decided to roll over for a tummy pet and the lancet kinda poked wrong. There was alot of blood but it was not a clean bubble more of a puddle. Could this affect the number? Now he has a big red spot in his ear under the skin(visible with flashlight) Size of a pea but flat. Poor little guy. Can I put anything on this? Should I be using alcohol wipes before, someone told me no because it stings but I am concerned for infection. Thanks again everyone.
     
  21. Andy & Pimp

    Andy & Pimp Well-Known Member

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    Oct 18, 2015
    Sounds like a bruise, it should go away in a few days to a week. You can avoid them in the future by holding some pressure on the poke for 10-20 seconds.
     
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  22. Liz & IttyBit

    Liz & IttyBit Member

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    We always use a piece of tissue and lightly pinch/hold the ear where you poked for about 20 seconds or so. It stops the bleeding and prevents bruising.

    ETA sounds like you nicked the vein, it happens, I just did it a few minutes ago. It has never to my knowledge affected our readings.
     
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  23. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    Sounds like a bruise to me too...it'll go away with time. One thing a lot of us use is Neosporin with pain relief ointment on our kitty pokes...seems to really help them heal up quickly and if you put a very thin film on before you poke, it helps the blood "bead up" (think oil and water)

    We've poked thousands..or hundreds of thousands ears around here....never heard of any infection from poking, so I'd forgo the alcohol...it's very drying
     
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  24. billysmom (GA)

    billysmom (GA) Member

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    Feb 26, 2015
    Another possibility.. has Sumo been treated for anything else lately? For example, has he been given antibiotics for an infection or has he had a dental or was he recently given a steroid shot? An in infection or bad teeth can raise BG. Also a steroid injection can raise BG and it sometimes comes down after the steroid clears the system. If any of these are the case, the switch of diet combined with resolving the medical issue could account for the drop you're seeing.
     
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  25. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    So glad Sumo stayed safe and you got a few more tests in to see what the glyburide is doing for Sumo. While we don't often see cats treated with glyburide around here, some of the principles are still the same as with insulin treatment. What I question is this...... since glyburide is only given once every 24 hours, as opposed to the twice daily schedule with insulin, and the action of the drug (pushing the pancreas to pump out more insulin), does that mean that a hypo event might go on for a longer period of time and take a lot more intense and lengthy effort to control than one resulting from exogenous insulin? Please let us know what the vet has to say about treating him now that his numbers seem to have lowered so drastically.
     
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  26. Missy

    Missy Member

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    Feb 3, 2016
    Nothing at all. The vet did notice some gum disease and I have started brushing his teeth. I looks at bit less inflammed. He also had very waxy ears that have now been cleaned. That's all.
     
  27. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Dec 2, 2014

    Just changing from dry food to all wet food can have a major impact on some kitties. I am so glad the people here were able to advise you about not giving the glyburide. Even though it is not the same as the insulin we are familiar with it still works by lowering glucose levels. With the food change and the glyburide you have been giving, the treatment plan looks like it really needs to be changed. Glad you are home testing!!! :)
     
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  28. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    This study I found seems to indicate that this is indeed the case:

    http://www.ncbi.nlm.nih.gov/pubmed/16324923
     
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  29. Missy

    Missy Member

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    Spoke to the vet and they were shocked about the numbers. They said this is almost unheard of going down so fast. They did say my meter was probably inacurate but I did state that the normal healthy kittys have a range of 4 to 6 ish on this meter and I was comparing to that. I am going to test him more to see if the numbers climb again. They said anything below 8 no pill. So on my meter I would guesstimate that to be 6.5-7. Still I find that to be too low to give a pill. Yesterday night he was at 12 and with no pill he was at 5 in the morning. If I had given the pill he might have gone too low. He would have to be consistent high numbers for a day to convince me to give it. Like you guys said better a bit high for a while than too low for a minute.
     
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  30. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    There have been MANY kitties on this site that have managed to get into normal numbers just with changing the diet. Dry foods are definitely a bad food for a kitty with a predisposition to diabetes. I would hesitate to give a pill even at 8mmol (144).....look at his numbers from last night WITHOUT a pill. It is possible that the diet change to all wet food with no dry could be all that is needed to get numbers back to the normal ranges. At this point I would continue doing tests....at least 2 hours after having food would give a basic non-food level and then again 2 hours after eating...would give an indication whether the pancreas is "kicking in" the way it is supposed to. If you do any more testing please post the numbers here along with the time since/after eating.
     
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  31. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Out of curiousity what vet clinic are you dealing with here in Winnipeg?
     
  32. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Feb 18, 2015
    @Tuxedo Mom Great info Mary Ann! You posted that link last night but I didn't read it then (all the excitement) and forgot to peek today so thanks for reposting. It sounds like the glyburide, if a hypo occurs, acts like injecting more insulin would, during a hypo. YIKES! I agree with you that I would hesitate to give the pill at any number less than 8mmol. I'd ignore the difference in meters (human vs. pet) in this situation because there is a 15% variance allowed in all meters so when you get a reading of 8 on a human meter that could be anywhere from 6.8 to 9.2. I think it is advisable to leave yourself a little more cushion rather than not enough. I also like your testing suggestions Mary Ann.
     
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  33. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    Exactly..because it is stimulating the pancreas it just keeps working and is not part of the "fail-safe" system the body normally uses. So as long as the medication is in the system it just keeps on working. Since it is a once a day pill. I would be VERY hesitant about using it at lower numbers of any sort!
     
  34. Missy

    Missy Member

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    Feb 3, 2016
    I am in Quebec. She is good vet and so understanding. She is very willing to humor me and maybe sometimes I come up with good info. She has saved many of my pets in the last 15 years most notably our dog last summer that was passing blood. It was food allergies, again a problem brought on by commercial pet food. I have learned so much in the past year on pet nutrition and I will never make the same mistakes again. Next time I go I will bring my meter and we will do a testing challenge, I hope she likes it. As per my research pet meters did not exist before 2006, she must have use a regular one before that. I think she thinks I would get confused with a human meter and I can see that but with all the help here I know what normal ranges on human meters are plus my healthy guinea pig cats provide me with good info. I think that is what she was hesitant about. She did suggest insulin and it was my decision to do the glyburide( It sounded easier at first but after some research this pill scares the hell out of me) Might get some insulin if numbers go back up.
     
  35. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi Missy,

    Great job getting the night time test data - and it's as valuable as I hoped it would be.

    I agree with the other members above who suggest that 8.0 even on a human meter is too low for a no-pill number. If you look at the data you gathered there was a drop of 7.4mmol/L during the night - without the tablet. BTW did Sumo have access to food during the course of that night?

    If Sumo were mine, I'd follow @Tuxedo Mom's suggestion to monitor for the time being. I also suggest letting Sumo fast for a total of 3 hours after the 'test' meal (assuming that Sumo has no issues with stomach acid) and get a test at +3 after the previous meal as well as the +2.


    Mogs
    .
     
  36. Tuxedo Mom

    Tuxedo Mom Well-Known Member

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    OH..I am sorry for some reason I thought you were in Winnipeg where I am.

    Your vet sounds like a keeper..she is open to your concerns, willing to work with you and willing to learn. That is the most important things in having a good vet. The differences in human meters to pet meter....according to MY OWN comparisons.....might be about 30% higher on a pet meter than a human meter. This is more important at lower numbers than at high numbers. Just for an example a few days ago my sugar kitty hit a 1.7 mmol on AlphaTrak2 meter (pet meter) and I retested on the same drop of blood on the Freestyle Lite meter (human meter) and it was 1.3 :eek: :eek:. At that pont BOTH of the numbers were WAY too low and I had to give Syrup and HC foods right away. Luckily I was able to get his numbers up without having to take him to the ER....but the point is LOW numbers are much more of a concern than high numbers (overall) and pet vs human meters are pretty close in the low number range,
     
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  37. Critter Mom

    Critter Mom Well-Known Member

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    I like this plan. :cat:


    Mogs
    .
     
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  38. Missy

    Missy Member

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    Feb 3, 2016
    I'm going to try and test as often as possible. He is getting better with testing but sometimes he will just not have any of it. I don't want to make it an unpleasant experience like we were doing at first and restraining him. That is the only thing in life he hates is being restrained so lots of cuddles and pettings usually gets him in the mood. If you even try to hold him in place a little he will bolt.
    Yes he had access to food during the night, it was gone by morning. Who ate it I do not know. I am setting up a wildlife cam right now that will take pictures during the night to see who eats. I do not think he has problems with acid but he does throw the biggest tantrum if he cannot see food. He will scream and pant and I think this is like a panic attack. I get concerned he will get too stressed.
    Little confused on the testing hours mentioned. So test before breakfast-feed-no food for 3 hours-test again? Or was this for supper?
    Thanks again everybody
     
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  39. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Shneaky! I like it. :cat:

    Step-by-step:

    1. Make sure that Sumo has had enough to eat and then keep him away from food for 2 hours (hopefully he won't get panicky if he has a full tum first).

    2. Test BG. (This will be Sumo's fasting BG level).

    3. Feed Sumo after the test then lift up all food again.

    4. Test 2 hours after meal.

    5. Test 3 hours after meal. (If he gets panicky after the 2-hour fast then don't bother with the +3 test - if he's anxious it will affect his BG so the +3 won't give any useful info in such circumstances).

    6. Feed Sumo and then carry on as normal.

    The controlled feeding and testing will hopefully give you an idea of how Sumo's pancreas is functioning.


    Mogs
    .
     
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  40. Missy

    Missy Member

    Joined:
    Feb 3, 2016
    You're the best! Thank you. Thankfully I am home for a while and will have plenty of time to do this.
     
    MrWorfMen's Mom and Critter Mom like this.
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