very low BG Please help [improving]

Reposting from the Vesulin Forum:

Hi, my cat was diagnosed with diabetes about four months ago, and has been on Vetsulin ever since; currently at 3 units twice a day.

This morning I used up the last of the vial and was about to head to the vet to pick up the refill, but they had closed much earlier than I was expecting. I've been asking around on various channels, and someone local says they have Prozinc. Can someone give me a quick and dirty on whether this would be acceptable for the next 1.5 days while I continue to research on my own?
​

Another question... how worried should I be? Is 1.5 days okay without the insulin?

 

Andrew, I know that someone will chime in to answer your questions, hopefully very soon. I wanted to ask if you were testing kitty's blood sugar at home so that you can tell what the effects of the Vetsulin for the last four months have been.

I do know that some members have changed from one insulin to another, but it was a permanent move to try to better regulate blood sugar levels. Vetsulin was actually originally Caninsulin and was formulated for dogs. Not all cats do well on Vetsulin. Prozinc is an insulin formulated for cats and is a longer lasting gentler insulin and you might consider using it permanently. You can read about it on the Prozinc forum in the yellow tagged stickies at the top of the page.

 

@Idjit's mom We have been taking glucose curves at home when instructed to by the vet. Initially at 2 units twice per day, there was not really a noticeable effect. We only just recently bumped up to 3 units per day, but have not done a glucose curve as the vet said we should wait 2 weeks for an accurate test. The first test on 3 units is actually next Tuesday.

 

I just got off the phone with a local animal hospital, and they say that my cat should be fine until Monday; we just need to look out for lethargy and other symptoms. I'm wondering if we should feed him smaller food portions in the meantime though?

 

Andrew, I would advise caution here about raising the dosage of insulin. You can test at home and not have to take your cat to the vet for curves. That's a high dose and we do not recommend increasing a dose by one unit, rather increasing by very small increments of 0.25 or 0.5 Units. Raising the dose by whole units constantly can put kitty into the position of bouncing:

Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high: (possibly contributing to your kitty's high BG at the high dose he's on)
BG goes low OR lower than usual OR drops too quickly.
Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

The 2 Unit dose might have been too high to begin with, and then bouncing happened, vet sees high BG and raises the dose.

We recommend a starting dose of 1 Unit, and then testing before every shot, and during the cycle to see how the insulin affects the blood sugar, every shot, every day. Testing at the vet is not going to give you daily or often times accurate information (travel and vet stress), so if you have the equipment there, use it.

We can help with information about these insulins, and more effective diabetic care paying attention to all the basic components of care: diet, insulin therapy and home testing can work for you to help better care for your cat.

I see you checked with a local animal hospital, and I am worried. I don't think it's good to abruptly withdraw insulin, and I think the 3 Unit dose, and even the 2 Unit dose is too high.

Please, please wait for an experienced person to weigh in here.

 

you can test your cat's blood sugar to see if he's too low, not just observe. Many cats are without symptoms until they aren't..very suddenly and sometimes catastrophically.

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX

 

@Idjit's mom Sorry, I must not have been clear. We don't take the cat to the vet for curves, we do them at home and email the reports to the vet. However, these curves are typically only done when requested by the vet.

My cat's initial dose was 1. It was raised to 1.5, then 2, and now to 3, over the course of 4 months.

So to make sure I understand you correctly... I should be doing a BG test before every shot? How often should I do a whole curve?

 

I'm reading those links now, thank you.

 

You should always, always test before every shot... to be sure the BG is high enough to inject the insulin. And..during the 12 hour cycle between shots. Andrew, your cat has been in jeopardy (no judgement, you didn't know) when you have been shooting "blind". Many vets are just not well educated with feline diabetes, but the information and support you need are here.

You can read about how to use Vetsulin HERE

You can read about how to use Prozinc HERE It's different procedure than Vetsulin in case you decide to use it..it's a good cat insulin.

 

You can do curves whenever you want and have time, but you need to test on a daily basis, before injections and at different intervals during the cycle between shots. The daily testing is going to provide adequate information to be going with right now.
What does kitty eat, what kind of meter are you using?

 

Since the diagnosis, he had been on an assortment of canned food, until about a week ago, when the vet prescribed Hills Precription Diet M/D. We did a few days of that, but were alarmed by some questionable reviews we saw online. Now he is eating only Wellness brand Core 95 Smooth Paté.

The meter is the Alpha Trak.

 

Ok, the AlphaTrak2 is a good pet meter, only problem is the cost of the strips, and you have to order online and wait for delivery. That's dicey if you get into really low numbers and go through a lot of strips. If you can afford it, great, just have plenty on hand and don't run out. Most of us use a human meter because the strips are less expensive and more available.

Let me check on the carb % of the cat food.

 

Regarding his BG levels, it has averaged 407.8 across 5 curves. Max 594, Min 294.

 

Just saw the tag on the other thread.
I never used Vetsulin or Prozinc and cannot give advise on the dosage switching over. I do not have that information.
That said, Prozinc is one of the more gentler, cat-friendly insulins.

 

Hi Andrew, we test before every shot to make sure kitty's blood sugar is high enough to need insulin, and also throughout the day when possible (some of us have day jobs and don't get to every day) to see how low the insulin is taking them. Seeing what's going on every day is more accurate than every couple weeks - for all we know kitty could have had a stressful day and their numbers are a bit different than usual the one day you test, you just wouldn't know.

Take last night for example, I checked my cat's blood sugar right before a shot and saw that it was 102. Our no-shoot number is 200, so if I had given her insulin without checking I could have sent her to the ER on accident.

I think most people here don't even do curves very often, though there's nothing wrong with doing them! Testing here and there every day presents a better picture than just one curve.

Hopefully a more experienced member will get back with you soon, but I would think that a different insulin is better than no insulin (you said the animal hospital said Galaxy would be fine til Monday - did they mean fine with or without insulin?). I switched my cat from Vetsulin to Prozinc (permanently) and the recommendation was to keep the dosage the same. Hopefully someone else can confirm this.

 

What I'm seeing on the food chart is some of the flavor varieties you are feeding is a bit above the 10% carbs that we recommend, but not bad. A couple of them are at 13%.

These BGs are too high and we need to work to get them down. If it was me, and it isn't, but if..I would get the Prozinc and change over to that insulin permanently. And with consultation with more experienced members, with close testing reduce the dose. The dose is too high Andrew and I think he's just bouncing like crazy.

What is your AT2 strip supply like? If pretty sparse, you can go to Walmart, pick up a ReliOn Prime meter and some strips and use the human meter. It's always nice to have a back up. You can help your cat get much better blood sugar levels, it's going to take some reading, learning and time for more testing on your part, but it can be done.

 

We just ran a test. Number came back 56. Reran to be sure and it came back 60. It's never been this low before. Trying not to panic.

 

How long since he's had his insulin shot?

 

10 hours ago.

 

Ok, you have the hypo info..the take action number on AT2 is 68...so we need you to feed some canned food (2 teaspoons with a little honey or karo syrup mixed in. We need to raise that BG, but not overdose him on sugar. Not too much food as we might need to have him eat more soon.

Don't panic, you got this!

 

Do you still have the Hill's DM canned food?

 

I'm honestly impressed Vetsulin has lasted him that long. The good thing is he's really far into this cycle. Like Lou said, give him a bit of food and we'll retest in...how many minutes for this Lou?

 

He's eating a small amount of food with some honey on it. We are out of the Hills.

 

Ok, Andrew you are doing great, test again in 20 minutes from the last test.

@Chris & China (GA)
@MrWorfMen's Mom

 

Just so you know Andrew, when a member is dealing with a hypo or low numbers, we stay with you until everything is resolved. Or we find someone to take over, you are never left on your own.

Change the title of your thread to very low BG Please help

Since there is no spreadsheet, post a summary every so often so that people do not have to scroll all the way up.

Vetsulin 3 units given at ???
+10 BG 56/60 - given small amount of food with some honey on it

 

I'm sorry, I can't seem to figure out how to change the title.

Vetsulin 3 units given at 07:50.

 

Find Thread Tools in the upper right corner at the top of your first post and click Edit Title

 

Time is relative Andrew, we are all over the world we use +10 because it's 10 hours after the insulin injection. When you start using the spreadsheet you will understand better.
So going forward when you test again, just put +10, 20 min and then the BG test reading.

 

17:47: B/G 73

 

Sorry, you're right. I should know better as I deal with normalizing date-times most days... Just feeling frazzled.

It's now actually +10 BG 73.
Previous number should have been +9.5 BG 56/60

 

Super, coming up nicely..take a deep breath or two, the first time is a bit scary, but kitty is not in danger. We want to test again in another 20 and see what he's doing.

Here's something to read:
Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.

Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) for AT2 - 68 or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.

Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

 

Hi and welcome to FDMB. Now let's get the kitty sorted.

You need to get your kitty's BG up to about 90/100. Do you have any slightly higher carb food available? Anything with gravy in it? If you have something with gravy, please give your cat just the gravy not the meat. You don't want to fill him up with food in case you need to get him to eat again.

 

Vetsulin
3 units 10:50
+9.5 56/60 food with some honey on it
+10 73

 

FYI - On Vetsulin you do not want your cat dropping below 90. While 68 is the warning level for action to prevent a hypo with some insulins, that action needs to be taken earlier with Vetsulin.

 

I've got dry food that hasn't been used in a long time. Unsure what brand or what the carb content is. Going to sift through the assorted cans that we feed my other cat.

 

@MrWorfMen's Mom
Linda, just to catch you up, Andrew ran out of Vetsulin and was offered some Prozinc or go without for 1.5 days. Went from 1 to 3 U of Vetsulin so far, with sporadic curves at home, no daily testing.
Then Andrew tested and got the first low BG.

 

I've got a Solid Gold Triple Layer Pate, Mousse & Shreds with an estimated 7% carbs. This doesn't look like it's got gravy in it. The next best is going to be Healthy Gourmet Flaked Tuna, which does have gravy, at an estimated 4% carbs.

 

Give him a tsp or 2 of the 7% carb food now and retest again in 20 minutes after he finishes eating please.

 

Didn't figure out which food to use so proceeded with test first.
~+10.25 100 no food

 

Proceed with feeding? I'm worried about overshooting and not having any insulin on hand.

 

Vetsulin AlphaTrak2
3 units 10:50
+9.5 56/60 food with some honey on it
+10 73
+10.25 BG 100

 

Thanks for the synopsis @Idjit's mom. I was just reading through the earlier posts.

Ok that BG is looking better. No more food and retest in 30 minutes to see if he is holding on his own.

Under normal circumstances if one were switching between Vetsulin and ProZinc you'd simply switch at the same dose. At this point in time however it is clear that the dose of Vetsulin is too high and needs to be reduced. Since the increases have been larger than we would have recommended, the last being a full unit, it's difficult to say what dose one would start ProZinc at.

@Andrew Galloway Before making any decision about the insulin despite what the vet said, has your cat had any history of ketones or DKA? If there is any history, then leaving him without insulin over the weekend is not the best option.

 

Most recent urine analysis was eleven days ago. Don't have a report from the vet, only received a phone call. There was no indication of anything unexpected, ketones or otherwise. Won't be able to get more specifics until Monday (Saturday now).

 

What is your kitty's name Andrew?

If he had DKA you'd know however ketones are another question as a lot of vets don't seem to tell their clients about them. Ketones can be checked with a urine strip or by bloodwork. Do you have any copies of bloodwork results from your vet? It's a good idea to get copies of all tests for your records.

 

We have no copies of any bloodwork results from our vet, and never thought to ask for them since they always told us they looked fine. I'll make sure we ask next time.

His name is Lucifer.


I assume he's saying "Thank you everyone" here, but it's hard to tell. His English is terrible.

 

Lucifer is very handsome. Gentle head bops and chin rubs, little guy.

 

Hello Lucifer! What a cutie! It's Ok your English isn't good. Our "Kitty speak" is a little rusty too but we get by!

I think for tonight given that low reading and the presumed absence of any ketone history, it would be a good idea to skip the dose tonight. Lows like that can cause some insulin sensitivity.

Tomorrow I suggest you test Lucifer at least 2 hours after any food (fasting BG) around the same time as you normally would be giving him breakfast. Then feed him and then retest about 3 hours after his meal. Post the results in Vetsulin forum and we can then help you decide if it is reasonable to leave him off the insulin until Monday.

 

Okay, just so I'm clear...

Normal feeding time is 07:30 Pacific Time, so the plan for tomorrow is:

• 07:30 feed
• 09:30 test
• 10:30 feed and test again? I think I'm misunderstanding the comment @MrWorfMen's Mom

Normal dinner time is in about 40 minutes. About to test again.

 

Vetsulin AlphaTrak2
3 units 10:50
+9.5 56/60 food with some honey on it
+10 73
+10.25 100
+11 BG 163

 

Andrew, as I hope to see you on the board now, please do me a favor and when you have time (and caught your breath from this adventure) create your signature and set up the spreadsheet so we can see the BGs on the grid.

1. Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the country/time zone matters) Be sure to SAVE when you are finished.
2. Another thing that will help us help you is to set up a spreadsheet like the one we use here. You will see how the trends and patterns emerge, and members can review his/her progress before offering suggestions or advice:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/

It's ok to edit the titles in the Vetsulin and here on the Main Forum now to remove the 911 as Lucifer is coming back up.
I'm sorry that things went a little sideways for a bit, but I'm so glad you are here and we can help out.

 

Nope. Assuming Lucifer will not have eaten for the 2 hours preceding his breakfast time, test him just before his 7:30 meal for a fasting BG. Then feed him as you normally would and then test him 3 hours after his breakfast. Since you have no insulin right now and aren't likely to have it by shot time tomorrow morning, we can use tomorrow's day cycle to gather some useful data to see what he's doing without insulin. Does that make more sense?

 

I think what Linda is suggesting (correct me if I'm wrong, @MrWorfMen's Mom) is:

• 07:30 test, then feed
• 10:30 test again

Ah, there's Linda with the clarification.

Welcome to you and Lucifer!

 

Sorry for the misunderstanding. Yes that's clear now, thank you.
Also, signature is complete. I'll work on the spreadsheet next.

 

Andrew, waving at you from Spokane across the state.

 

Did you get another test again yet? If not please do so. The karo you mixed into the food doesn't stay in the system long so we need to make sure Lucifer's BG is holding or rising on its own and not dropping again.

 

Hi State-buddy.

How should I proceed with dinner for Lucifer tonight, considering the lack of insulin? The emergency dish he received earlier was about 1.375 oz (1/4 of a 5.5oz can), plus honey. I'm worried about raising his BG too high.

Edit:
I was planning on testing in about 15 minutes (feeding time).

 

Test him now then you can feed him again whenever you are ready. We need to see what his BG is without anymore food in the picture now. We'll decide about the honey once we know what his BG is now.

 

Vetsulin AlphaTrak2
3 units 07:50 PST
+9.5 56/60 food with some honey on it
+10 73
+10.25 100
+11 163
+11.5 BG 140

Spreadsheet still in progress, sorry.

 

Andrew it's great that you are getting the spreadsheet done and absolutely wonderful that you are home testing. No apologies required.

Looks like a high normal end of cycle for Lucifer. And given the low he had earlier, that number may be a bit inflated from a bounce. Anxious now to see what his BG is in the morning.

At least you get to have a nice worry free night's sleep Andrew. Lucifer is looking mighty fine right now.

 

Should I feed him a normal or reduced dinner?

 

Just feed him as you normally would. No need to skimp on the poor guy. He's had a hard night getting poked so much.

 

@MrWorfMen's Mom Done, thank you. Btw, is Worf named after the Klingon?

 

Just logged online and saw the tag @Idjit's mom. Looks like you and @MrWorfMen's Mom are doing s great job looking after Lucifer.
I have to leave for an apt shortly so can’t stay at the moment. Will look in later
Bron

 

Yes Andrew. Worf is my precious feral rescue found at 5 days old and reared by humans so he got named after the Klingon because his childhood was similar and he "klung" onto life despite the odds!

Thank you for getting your spreadsheet done and linked despite the events of this evening. We rely on the SS to help us help you so you are all set now.

 

You are all amazing human beings, thank you very much for you help today. You saved us an expensive ER visit, and probably my sanity.

 

Our pleasure! We're one big happy family around here and we're glad you found us!

 

LUV the new moniker! LOL!

 

Andrew, I got lots of help and support when I arrived, I don't know enough yet..still working on that. But like Linda said, we are family..sometimes warts and all.

 

Heh, I exist to serve.

 

Lucifer's BG is 550 this morning, before food. Should I feed him a smaller portion than usual, a normal portion, or nothing at all?

 

Feed him as you normally would. Can't starve him just because he doesn't have insulin.....that would be the absolutely wrong thing to do. I'm not liking that high number as I'm sure you aren't either but it's likely, at least in part, a product of a bounce from the lows yesterday. Let's see where he's at 3 hours post meal to see if his BG has dropped at all.

 

a belated welcome, Andrew -- I was distracted yesterday and missed all the drama

I'm just a bit south of you between McKenna and Yelm -- I'd offer you some Vetsulin but I already donated my leftovers to a rescue group -- I do have leftover U-40 syringes if you need those -- the rescue group didn't need them

are you able to get that ProZinc reasonably easily? it IS much easier on Lucifer's system -- I switched from Vetsulin to Lantus and it makes a world of difference -- still need to be cautious, test often, plan ahead

 

Thanks @CandyH and Catcat . We're planning on asking the vet about ProZinc on Monday when they open. They have a lot to be caught up on now.

 

Just a heads up, we were able to pick up the Vetsulin refill this morning. Lucifer was given a reduced dose of 2 units since he'd been off it for a day and a half. Does that sound like a reasonable approach? I didn't want to overwhelm him. We'll be testing throughout today and hopefully be able to gauge an appropriate dose for tonight. Of course, any and all advice is welcome in the meantime

We are looking into ProZinc as well.

 

Sounds reasonable to restart back at 2u. We would have recommended backing up to at least 2.75u and possibly 2.5u anyway. You can always increase if need be. Hopefully you'll see his BG coming down to more appropriate levels very soon.