Very different glucose levels for Day and Night

Hello Everyone!

Hope that you are all ok!

I am going to make my first curve with Sushi tomorrow but I am really confused about something.
There was a problem with my delivery from Vetuk and I almos ran out of strips, so I couldn't take more values until today. But from what can see on my spreadsheet, it seems that Sushi's glucose levels are lowering nice during the day ending around the 20's. I was really hopeful because with that on the highest at PMPS, he gets into the normal glucose levels at nadir! But then after we go to sleep and he goes to sleep (he doesn't eat while we are sleeping, even with food there, he just sleeps) his numbers go really really high!
My question is: Should I try to extend my curve from AMPS until the nadir in the middle of the night? Because clearly what's going on during the day is not the same as during the night. And giving him more than he is taking now, if he reaches normal levels already at the night's nadir, is going to put him in hypo, right?

He free feeds during the day except 2-2h30h prior to the testing.

I know that Humans are different from Cats, but I had coffee with my Friend today, her daughter is diabetic, and she told me that used to happen with her because while they are sleeping they don't spend their energy on anything and it accumulates. She said that, with her daughter, they had to switch insulin for a slow release one.

What do you all think?? Should I try and push myself and try a longer curve to see what's happening? Would that help?

Thank you so much in advance!

Love,
Sara

 

Hi Sara. I would definitely try to find his night time nadir, if you can. I use Vetsulin which is just Caninsulin with a different name, and I frequently have to give different daytime vs nighttime doses. Mine is usually the reverse, he's higher in the day and lower at night, but it comes down ultimately to the same thing. Most cats on Caninsulin will have a sharp, fast drop around the +3 hr., then slowly rise till around the 6+ / 7+ hr when some of them will have a slight, gentler drop in BG. Obviously these numbers are not exactly the same for every cat but usually work as a good guideline. If you can identify his nighttime nadir you may be able to adjust his PM dose to keep his BG lower thru the night.

 

More data points will help you see how he responds at different times, so it is worth doing. With the in and out insulins, you can adjust the doses for different responses over time.

Also, if you use a timed feeder, or freeze some food to put out for him to eat overnight, that may help balance lower night time levels and keep him safe.

 

Thank you Lucy and BJM!
I will start tonight, try to do it all night as much as I can and tomorrow during the day... I will try to do it hourly until Nadir and then every 2h...

@BJM, Sushi's numbers start to rise when he is without food! He eats last time when we go to bed and he sleeps through the night. At the AMPS is when his numbers are really high.

 

Maybe a little timer with a bell or alarm to wake him to eat?

 

@BJM So it can be the fact that he doesn't eat during the night that makes his glucose levels go up?? That is so confusing! I thought food would raise them!
I don't know if an alarm would work... Our cats always slept through the night with us even with food available... Even when my husband travels and leaves in the middle of the night, they don't leave our bed until their usual time...

 

Hmmm. As far as I know, not eating overnight should not raise his BG, but I'm certainly no expert. The more tests you can get in, the better. Right now there isn't enough information in your spreadsheet for us to be able to safely advise you. There could be one of a few things going on, but without seeing more test numbers and a curve, it's a mystery. Please do your curve tomorrow, and in the meantime, and also after your curve, see if you can get in a few more tests. Then we'll be in a better position to help you.

 

I'm on it, Lucy!
Thank you so much!
Starting a 24h curve today... Had a very high reading just now, just to shake things up a bit...but he was really nervous wanting to eat and I got nervous as well... Oh boy...This s going to be a long night...

 

Never a dull moment when you're doing this sugar dance, lol. It'll get better, don't worry! Sending you some coffee for your late night sustanance!

 

@Squalliesmom Thank you, Sweetheart... He purrs while I poke him...it's depressing! LOLOL!

 

Smokey use to drop during the night. Now he drops during the day. Have no idea why he switched.

 

Good job on the curve. He definitely drops and in that +3-5 hour window we often see with Canninsulin. It will be interesting to see if he has similar numbers during the day.

 

You're very welcome, lol. Sushi sounds like a real sweetheart!

It' great to see some numbers on your spreadsheet, good work!

 

If he winds up going lower than he is accustomed, he could bounce high by morning.

 

Good Morning Everyone!!

I wish I could have taken more numbers but I fell asleep... Thankfully it was after the numbers starting to go up again... But I can do it today again during the day...
We'll see! I am having the feeling that he will have a marvelous curve during the day, with no weird numbers in site, just so that he can confuse us all...LOL...

@woodsywife Let's see how will his numbers be during today...

@Sue and Oliver (GA) Let's see how today goes!

@Squalliesmom Sushi is adorable!

@BJM , yes, I now understand what you are saying... ~

Thank you all!! Let's see how the day goes!!

 

Well...long night, long day and almost done and the odd numbers are nowhere to be found... LOL...
But I think there are some adjustements that need to be done...

What do you all think??

 

Hi, Sushi's Mom. I looked at his SS, you did a great job on the curve!

Looks like he hit nadir at +6hrs today. What kind of food is he eating, and do you know the percentage of carbs?

 

Hey Lucy!!

Thank you! I did my best!

He only eats wet food. At this moment he eats pretty much what he feels like between Granatapet delicatessen, Purina DM (favourite) and Thrive complete.

I don't exactly know the percentage of carbs, but I know that they are all very low carb. Am I wrong?

 

AAHHH...and lots of Orijen freeze dried treats! Everytime there is a poke...

 

The DM is about 7% carbs. I just looked up the others and they are both very low carb, indeed! Here is the list I referred to:

https://docs.google.com/spreadsheet/ccc?key=0Aq4WIfRfL3G1dDd2dkNtMnNoMDZYaDVxTGtSd1dmWmc#gid=0

So...in that case, his BG isn't being affected by high carb food. The next logical step would be to increase his insulin slowly and gradually until you get him into lower numbers. I wouldn't recommend anything other than small increases, monitored closely for at least three cycles to see where it takes him. As always, you should consult with your vet before making any changes.

Do you feed him before his shot? The procedure we recommend here is test, feed, shoot. For those of us using short acting insulins like Caninsulin/Vetsulin it's best to wait about 30 minutes after a meal before shooting, that way kitty has a full tummy to help buffer that initial sharp drop. Also, is he eating right before bed-time? This might have some bearing on why his numbers seem to be higher at night.

 

Thank you, Lucy!

Yes, I won't make any changes without the vet indication. Tomorrow is the day for me to take his curve and any notes to the vet and she will call me afterwards with any changes to be done. He has been going up from 0.5 units. And the dosage stays for a week until further changes are to be considered.

I have to be honest... They used to have a very strict feeding schedule before the diagnose for diabetes, but he gets really nervous without food now... To the point of me not being able to handle him to test... The stress agravates his asthma... So have been walking on egg shells here and I give him what he wants, when he wants. I try not to feed for 2h-2h30 prior to the shot, when I can...
Yes, I always feed him before bed...

I clearly need help with the feeding schedule... What changes can I introduce that won't make him very nervous?

 

I think you may be having a duration issue with the Caninsulin - notice how fast it rises after the nadir?
Is there any way you could test and shoot every 8 hours?

 

He will probably stay hungry all the time until you can get his BG down. Diabetic cats are either not properly utilizing the insulin they make on their own, or are suffering from a lack of insulin. In either case, when enough insulin is not present, the cat cannot utilize glucose properly; instead of being absorbed by the organs it builds up in the bloodstream, essentially starving the cells. This is why diabetic kitties can eat a large amount of food and and still be hungry all the time, often experiencing weight loss, as well.

A lot of cats do better eating several small meals throughout the day, rather than one or two larger meals. But to truly stop "the hungries" you'll have to get his BG down.

I could be wrong about this but I imagine that, as his insulin dose increases and his BG is better under control, you will get better duration from the Caninsulin. Squallie started out not getting much duration from it, too, but as his diabetes became better regulated, he got more and more duration from the Vetsulin. Now, at times, it lasts a good bit beyond 12 hrs.

 

And we are back again to the lows!!!
He was 22.1 just now... AMPS...

 

I went to the vet and I will only leave the results after his values start to rise... I am watching it closely, since they are dropping very low...

@Squalliesmom I don't know much about insulin, but I don't think that, with 7.3 on nadir like today, we can raise it much more...

@BJM every 8h wouldn't be very good for me, as I have to work away from home some days and I am away more than 8h... My husband doesn't seem to want to learn how to poke and shoot and he is away from home at least 12h a day anyway... Let's see what the vet has to say about these numbers... But I see what you are saying about the duration...

Thank you so much for all your help!!

Love,
Sara

 

Your curve has good information. He dropped, and into nice ranges around +6. The bad news is that it looks like the insulin then wore off (or he had an immediate bounce and then wore off) and he stayed in high ranges from then on. Sometimes an increase can help with that duration. We'd suggest to increase by 0.5 or less, test for a few cycles and then increase again if necessary. Sometimes an increase of a whole unit is too much.

Sometimes cats do okay with Canninsulin. Sometimes it is really hard to adjust the dose so they are in better ranges without going too low and without bouncing. And sometimes the duration just isn't there.

If he were mine, I'd ask the vet about a small increase and keep collecting data.

 

Yes, I see. Not a whole lot of wiggle-room there. But you do have a little bit.

I agree with Sue and Oliver. That's exactly what I would do, too. On an Alphatrak meter, the generally-accepted cut-off for hypoglycemic risk is 68 (I think that's around 4.8 for you, but I'm not sure, so check my math before relying on that number!) so he could go a tiny bit lower and still be safe. However, I don't think most vets are comfortable with them dropping much below the low 90's (5.something?) so see what your vet advises.

I know in the UK all diabetic kitties are started first on Caninsulin, but if it doesn't seem to be working for you maybe your vet will offer you an alternative (human) insulin.

 

It may be possible to get on Lantus if you continue to document that the Caninsulin wears off too fast and doesn't adequately controll the glucose.

 

Hello Friends!

@Sue and Oliver (GA) @Squalliesmom @BJM
I totally agree with the 3 of you... I am still waiting to hear from our vet, but another vet from the clinic saw Sushi's values and was very happy with them. Said that he already sees progress and that this usually takes time.
I'll see what our vet says but I will suggest a 0.25 increase. I have new U40 syringes with 0.5 unit and I am sure I can halve that.
I will continue to keep a close eye on Sushi's numbers and if they keep showing that the caninsulin doesn't last what it should, I'm sure we will be able to find another insulin that can. They told me they have a success rate of remission of every 4 in 5 cats. So, I am assuming they know something about that... Lol...

Do you know how precious these talks with you all are?
Thank you...

 

So you have some references when talking to the vet. We generally consider a cat well regulated if they are in the lower 200s at pre shot and in double digits at nadir, but not below 45 which is nearing hypo territory. Cats in remission, off insulin, range from 40 - 120 with the majority of the time in double digits.

He is in decent ranges at nadir - not as low as he could be - but pretty good. It's the pre shots that are high and they can be a result of dropping low fairly fast and then bouncing back up or they can be because the insulin isn't lasting long enough. Hard to tell yet.

Glad we can help.

 

@Sue and Oliver (GA) She is using an Alphatrak meter, so her cut-off for hypo would be around 68, wouldn't it?

 

So glad to be able to help you! By the way, could we know your name (other than Sushi's Mom, lol)? I'm Lucy, nice to meet you!

 

Yes. Thanks, Lucy. I forgot that. Subtract about 30 from thosefigures to get a very rough gauge of the ranges for AT meters.

 

@Squalliesmom Lucy, my Dear, I always sign with my name! My name is Sara!

Nice to meet you, Lucy!!!

I am now armed with knowledge and We are going to balance this cat and then head for remission!

I'll let you know what the vet said as soon as I hear from her.

Thank you, thank you, thank you!!!! If only you knew how grateful I am for you support...

 

[QUOTE="Sushi The Cat, post: 1532612, member: 13709"...]I always sign with my name! My name is Sara![/QUOTE]

Sorry, my bad! I went back through the posts and did, indeed, find "Sara" there, lol. My children think I'm blind to anything not immediately related to feline health and well-being, maybe they're right!

 

Hello Dear Friends!!

@Sue and Oliver (GA) @Squalliesmom @BJM

How are you all?

Just to let you know that I talked with the vet and she said straight away to raise to 2.5U. So I am going to start tomorrow and see how it goes...

Love,

Sara

 

Thank you for the update, Sara, I hope this does the trick! Just be sure to monitor for hypos, fingers and paws crossed that Sushi won't have any . Right now my Squallie is all over the place with his BG, it's making me crazy, lol. Take a look at his spreadsheet, you'll see what I mean, I never know how much his next dose is going to be! (BTW, don't do what I'm doing, it's not the optimum way to treat, and is definitely not something someone new to this dance should do!)

 

@Squalliesmom

Hey Lucy!!
Don't worry... I won't change his insulin dose unless I realise that it is too much and I have to return to the previous one...

I started the 2.5U today, as I had a busy few days and work today and couldn't monitor it properly. I will carefully monitor it during today and tonight... Let's hope it will be ok, as I'll have a very busy week ahead. My parents are in the UK to visit me for the first time in almost 2 years.

Hope your Squallie is doing better with his BG!

Thank you for your support!

Love,
Sara

 

Hello everyone!!

I think I need some help here... I raised Sushi's insulin for 2.5U and I am checking his BG at Nadir, and it is higher than it was at PS... Can this mean that his BG dropped too low and his body panicked? Because we could already see the clear curve with the 2U... Should I reduce it to 2.25U and try it like that and see if it helps or do nothing and keep monitoring in the next shots?
I was hoping I could get this on track between today and tomorrow because my parents are here and I was counting on being with them during the week. I am desperate for some Human time...

Thank you so much for your help

Love,

Sara

 

Ok... So at his usual nadir he was with the highest BG reading for today so far... What I feel I have to do is reduce back again to 2U, check if his levels go back to where they were, and then increase to just 2.25U and see where that takes us.

What do you think?

 

Needing some human time is sure understandable.

I don't know. Yesterday's curve is certainly different, and sometimes too much insulin can act like too little. It is up to you. I would probably have suggested increasing by 0.25 rather than 0.5 and raised again if needed.

Up to you. Get some numbers on the 2.5 and see if this cycle was just weird. Or reduce to 2.25 and see if the numbers improve. (i don't think you need to go back down to 2, just 2.25)

 

@Sue and Oliver (GA) I haven't been with anyone in my family for nearly 2 years, I can't aford the expense and I think by now you already know how this cat has been driving me crazy, between the asthma and the diabetes... I feel that I really need a break and just a few days of being spoiled around London with everything paid for would do the trick. They will only be here until Friday...

I raised to 2.5U because that was what the vet recommended. But even if I just drop to 2.25, I'll have to be stuck at home poking him around... the 0.25 may be enough to give us weird numbers again...

 

Hi Sara. We can all relate to the need for human time!

I agree with Sue, I would try to get some more readings at 2.5 units and see if his numbers improve.

It's hard not being able to spend as much time with your family as you'd like . Maybe if you can arrange to be home to monitor him for the 2-3 hrs he seems to drop the lowest...? I don't know, I know you want to see your family but also want Sushi to be safe. Sorry I can't be more helpful here. Whatever you decide to do, keep us posted on Sushi's progress, please!

 

He drops to his lowest at 11, 12 and 1 AM and PM... This will destroy my next few days and nights. It takes me around 1h to get to London where my parents are staying and another 1h to be back. This is not going to work...

 

Then I might drop back to 2 units while they are here. My thinking is that I am a little nervous he will suddenly drop low on the new 2.5 dose. 2 units kept him in safe numbers; 2.25 should be fine but it is an unknown. We aren't sure what is happening with 2.5 but it seems wonky. You can start anew once your parents have gone?

 

Won't that be a problem? To drop back to 2 units until Thursday evening and then start fresh again with 2.25?
I feel horribly right now, but I won't be able to leave the house while I am not absolutely sure that he will be fine while I am gone...

 

It's only an increase of 0.25 so it's pretty standard. He was on 2 units and had some nice numbers midcycle. The insulin wasn't lasting long enough, but that is a common issue with Canninsulin. Or am I missing something you are worried about?

 

My concern: Is it safe to drop back the insulin to the 2 units again? After being on 2.5units today?
Will we just go back to the numbers we were before?
Am I being a horrible owner?

I agree that the caninsulin doesn't seem to be lasting long enough, but the vet says that it is still early to change, since there are still a few adjustments that can be made...

 

I

Since you have only been on 2.5 one day, I see no issue dropping down to a level that you know is safe, knowing you can't be around. You probably will go back to the numbers you had on 2 units but they weren't awful. We were thinking they just needed a slight dose adjustment.

NO, you are not a bad cat mommy. You are doing the very best you can for your kitty. And you deserve, and need some time with your family. He will be in decent values (better too high than too low) and you can start again when you are home again.

 

Thank you, Sue! I was starting to freak out a little...

I will drop his insulin to 2 units again and monitor it tonight to see if it goes back to normal. And Thursday evening I can go up to 2.25 units and see where that takes us.

Lots of Love, Dear Sue!

 

@Squalliesmom @Sue and Oliver

Sushi is with 3.4 at +4! I noticed he was quiet... I gave him only the 2 units.
I fed him already, gave him a few low carb treats and 3-4 regular carb treats to see if it doesn't drop much more, since he usually only reaches nadir at +5/+6...

What more should I do??

I won't be able to be with my parents tomorrow or go to sleep anyway...

 

I'd test again in 30 minutes.. Do you have some gravy food if he would continue to drop under 50? You can give him the gravy off the food - just a teaspoon or so - and see if that brings him up.

I am glad you went with the 2 units and not the higher dose!

 

They never ate higher carb foods than the ones I am feeding now. What I have higher in carbs are these Felix treats http://www.sainsburys.co.uk/shop/gb/groceries/felix-goody-bag-original-mix-60g, which I gave him a few, I have orijen dry food http://www.zooplus.co.uk/shop/cats/dry_cat_food/orijen/45156 but it says in the package that it is low glycemic with only 5.2g carbs /100g and I have Royal Canin sensitivity control pouches http://www.royalcanin.co.uk/product...ry-diet/sensitivity-control-so-chicken-pouch/

I am going to test again now.
What can I do??

 

He is with 3.6. This is 30 min after the 3.4.

He is very quiet.

 

You feed him to bring him up IF you need to. So if he is dropping and under 50, give him a little of his regular food (only a few teaspoons) and retest in 20 minutes. If he gets down to 45 or lower, mix a little honey with his regular food.

 

You want three rising numbers and then you relax.

I know this is a little scary but it's really good news. He is moving down in numbers (what you want). It is very likely he will bounce for tomorrow morning so be higher than normal. That would be good news for the chance to see your parents because he will be higher.

 

Ok! He has been eating on his own... Twice since the 3.4

I am sorry, but this is the first time I get a reading this low and it is scary. I don't think I will be able to leave him tomorrow until I know for sure that he won't drop again... Even with a starting BG value of 20 he never dropped this low.
Yes, it is good, but OH BOY IT IS SCARY!

Thank you for being right there...I have nobody else to count on...

 

3.0 now...

What should I do now?

 

Do you have some honey or syrup? Mix it with a little bit of his food. If he won't eat, rub some honey straight on his gums.

 

Yes, of course! Diabetic cat owner with no honey or syrup??? No way... Honey!

On it!!!

 

How is he doing, Sara?

 

The honey raised to 5.8... I know that this is temporary...Let's hope it is enough until we pass nadir...

 

It may last or not. Another test in 20 minutes or so. You want three rising tests.

 

Yes, Dearest Sue... I'll be doing that!

Thank you!

 

9.2, Dear Sue

 

Retest 1h after? Or 30 minutes?

 

Make it fit your evening. 30 minutes if you think you can then relax and sleep.

Probably he'll be pretty high in the morning, with the expected bump and the honey rising his number. So you could give 2 units or a little less, leave out some food and go see your parents. This was really a gift because the day before a low cycle is usually high.

Congrats on your first hypo! Next time, if there is one, you'll know just what to do!

 

Sweetheart, my evening is long gone... It is 1.30 am here... lol... I'll retest at 2 am and then go for some deserved rest until 6.30...

So you think that this low bump was a result of yesterday's high wonky levels?

I dont think I'll be able to leave him alone tomorrow... What if this happens again and I am not here?

I wouldn't be able to do this without you, Dear Sue...
I can't thank you enough... You are an absolute star, you know?

 

I am guessing the low cycle is a delayed result of the raised dose - but it's a guess, no more. Wait and see where he is in the morning. Most likely he will bounce and be super high. You could give a reduced dose and leave out food. Cats usually eat to bring themselves up if they drop low.

You are welcome. It's the way this place works - people help other people because they were helped. You'll be able to pay it forward.

 

Sara, so sorry I wasn't around to help, too, but you're in wonderful hands with Sue and Oliver. Sue has helped me many times! How is Sushi doing now? How are YOU doing? I know how scared you must have been!

 

@Sue and Oliver (GA) Yes...I'll sleep and see how he is in a few hours... It is better to decide after a long *cough* restful *cough* night of sleep... Tomorrow I'll also drop the developments of tonight at the vet as usual. I think that this deserves the vet's acknowledgement...

Yes, I know that is how this place works... but it is still a choice to help... Always... AND I AM SOOOO GRATEFUL FOR YOUR HELP!!!

Lots of love,

Sara

 

@Squalliesmom It's ok, Sweetie... Sue was my Star tonight! I am tremendously grateful... And to you too!
He is at 15.3 now, so I am off to bed for my night nap...
I was super scared! I was so happy when Sue answered straight away... I can only imagine what could have happened if I wasn't monitoring his glucose!!
Sushi was fine...just super quiet, which is not normal. He was like that since yesterday...

Lots of Love, Sweetie!!

Sara

 

You too, Sara! Hope you can get some sleep.

Sue is a star, she's awesome, helped me many times!

Congrats for surviving your first hypo! Please let us know how Sushi is tomorrow!

Lucy

 

Hi Sara,

Wondering how things are looking this morning? Maybe it's time to start a new thread? This one is getting long....

 

Hello Sue!! Hello Lucy!!

How are the both of you???

It is almost time to the pm shot... Lol... He is much better today! He is more himself and played a lot with his brother. But he is still with some wonky numbers.... but no hypos. I hope we will be back at where we were in the next few days...
Dropped his values at the vet and she told me to keep him on 2U and see if he goes back to where he was before and then we will go from there...

@Sue and Oliver (GA) Have I thanked you with all my heart???


Yes, it may be the time to start a new thread... What should I call it??

 

How about "Dropping Sushi's Dose" or "Starting Sushi Back At 2 Units"? Or "Regrouping After Hypo"?

I'm really glad he's doing so much better today! I looked at his numbers, I see he's still getting that big drop around +4 to +6. He's certainly consistent, at least, lol.
Sara, do you remember what his numbers were at the vet's, when he was first diagnosed? I scanned through the thread but didn't see them (but that could be me, doesn't mean they aren't there somewhere, lol!)