Low Sugar

Hey guys, so Lola has been creeping up in pre-shot numbers and had moderate response to insulin, which prompted me to increase her dose a couple of times on advice from the vet (she’s also had blood/urine tests to check why it’s increasing). Normally she’s in the 170-190 mg/dL range (I’m converting from mmol/L because I know most of you guys use mg/dL), but she’s creeping up to have pre-shot values of 210-230 mg/dL. I’ve done spot checks as well.

She’s on 2 units ProZinc right now, and I did a curve today. Her AMPS = 229 mg/dL and nadir = 144 mg/dL at +10, although she pretty much reached the low around +7 at 160 mg/dL. Her PMPS = 190 mg/dL, and I’ve previously given 2 unite at that level, which previously produced a +5 of 137 mg/dL, so I considered it safe.

But now, at PMPS = 191 mg/dL, she now has a +3 of 94 mg/dL. I’ve fed her some extra food and will test again in a couple of hours. How concerned should I be? Also, how low would her sugar need to go before I should seriously consider a midnight vet visit? I’m sure I’m overreacting, but I worry when this happens...

 

The first greens can be shocking, but 94 is a very safe number! You might check again in an hour to see if she’s still dropping. On a human meter the number to start taking action is 50, and even at that number you can usually steer the number up at home without a vet visit. I would only consider a vet visit for Spot if he kept dropping after intervention and he was starting to show symptoms of hypoglycemia.

You can take this moment to read up on hypos and how to treat them in case you need it later on: http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

 

94 is not a take action number, it might be lower than you are used to, but it's not critical. 50 is the take action number for human meters. You can review the hypo instructions HERE to see what to do in an event.
If you are worried, test again 20 minutes after the last test to see what she's doing. If you have given her food, that will likely bring the BG up.
Please post after that test and tell us what is the reading.

 

Please remove the 911 from your thread title. Also, I tried to look at your spreadsheet and wasn't able to view any data past 3/15/18, and there is no new tab for 2019. Might just be me, but I thought I would mention it.

 

Thanks guys for the great info and advice, I appreciate it a lot. I’m going to test her again in a minute and will post those results.

Also, I had just continued the spreadsheet into 2019... that’s weird that you can only see to March 15, 2018. I’ll make a new share link and change my signature, so hopefully that will work - give me a moment.

 

Okay, she’s at 139 mg/mL, so that’s good. She seems very playful as well. I’m assuming she’s safe and I could go to bed? It’s quite late and I have a long commute ahead of me...

 

Yes you should be ok to go to bed. Don’t be surprised if you see a higher preshot number tomorrow morning since she’s not used to going this low.

 

Right, for sure, I’ll keep note of that. Thank you again!

 

Spreadsheet fixed, thank you.

 

Hi. I'm glad to see that you are getting mid-cycle tests now. Without them, you really cannot see how a dose is working. I see that you dropped her dose this morning. Why? That 94 was not a bad number at all. You WANT to see her getting in those dark greens.

 

I know, however I was advised that after a lower than usual blood sugar value, diabetic kitties can be more sensitive to insulin. I didn’t want to chance it because I couldn’t get anyone to do a midday test for her, and I commute 2 hours to work, so midday tests can’t be done by me.

Also, her pre-shot blood sugar (PMPS) the following evening was 158 mg/dL, which is below my no-shoot threshold. If she’s going that low on 1.75 units, it seems like a higher insulin dose would be unwise, don’t you think?

 

So this morning her AMPS was 209 mg/dL and I have 1.75 units, which produced a +6 of 148 mg/dL. However, her PMPS was a little lower at 187 mg/dL, and her +3 went all the way down to 106 mg/dL.

Any idea why she tends to go lower at night? Also, do you think that 106 mg/dL at +3 is a value where I could safely call it a night and get to bed? Early morning tomorrow as always... alas, life as a busy grad student I’m afraid.

 

Alright, so her blood sugar as of right now (I just retested) is 115 mg/dL. Looks like she’s pretty steady, so I’m going to get to bed.

Any advice you guys have on why she goes lower at night would be great

 

A lot of cats run lower at night. Mia has always been backwards on that, but she is special.

UPDATE: I wanted to add that cat's are often highest first thing in the morning. (That part, Mia agrees with.)

 

We have a (human) friend that is diabetic that we often learn things from. He said that they have the "Dawn phenomenon", which I understand to mean that blood sugar is highest first thing in the morning...from which you could then infer that it would be lower than that during the previous night, I assume? Whether the Dawn Phenomenon would apply to cats or not though, I don't know.

But regardless, Whispy does usually run lower at night. I've always thought maybe it is because he is less active during the night and therefore eats less (because whenever he passes a food station, he ALWAYS stops to grab a bite, whereas at night he is in bed with us almost all night). Or it may have nothing to do with that at all, and it is just this "cats go lower at night" weirdness that no one can explain.