? What if u missed the signs that kitty was ready to go off insulin and instead created a crisis?

Discussion in 'Feline Health - (Welcome & Main Forum)' started by DinahCat, Jan 7, 2020.

  1. DinahCat

    DinahCat New Member

    Joined:
    Jan 6, 2020
    Brand new to forum as of last night. 16-yo domestic short hair that has been on twice daily Lantus for 6 years and Fancy Feast classic chicken pate. Fine until last weeks. Think I missed some signs...

    Desperate for advice on whether to dose or wait 6 more days until an appointment with an internal medicine specialist (current course recommended by vet)?

    Kitty (Dinah) was fine for 5.5 years, but has had an odyssey over the past couple of months. Current vet recommendation is to withhold insulin. Comprehensive details below. Thanks to anyone who reads through it and can give advice on - to dose or not to dose?

    ======================

    Imagine that your 10-yo cat was diagnosed as diabetic 6 years ago (rapid weight loss and intense thirst). And imagine that, for the past 6 years, you didn't know about this forum, or the concept of TR control, or the forum's spreadsheet, or not to use (very small amounts) of dry food as a treat for getting injections or ear pricks. But you have been doing just fine regulating your cat (healthy, fine clinically, seemingly playful and happy, etc) on twice daily injections of Lantus and Fancy Feast chicken pate until just these past few months, with the last 4-6 weeks being particularly challenging to figure out.

    Over these quite successful years, she has gradually required less insulin and less insulin. Never more. Year 1 and Year 2 at 1.0 to 0.75 units per dose. Years 3-4 at 0.75 to 0.6. Year 5 going 0.6 to 0.4. In the last 6 months, she's been showing the need for 0.4 to 0.25 to 0.1 and showing signs that 0.1 may be too much relative to her historic norms. On top of all this, 0.1 units is extremely difficult to dose accurately, as the residual liquid in the syringe needle itself is rather significant relative to the actual dose volume. So one extra little bit of pressure or one wiggle by kitty and significant-relative-to-her-very-low-dose insulin is injected. You start noticing lethargy and her pre-shot BGs much lower (or higher) than historic norms. Sometimes very much lower or very much higher. [She is not on TR. That concept is brand new to me upon finding this forum yesterday. Historically, she has been 250-300 pre-shot falling to, and cruising at, between 80 and 120 during +3 to +9. This regimen, while not TR, has worked. For literally 5.75 years.] The recent pre-shot numbers on the 0.1 units dose might show 80 or 60 or 400. I only give if she's above 275 based on what has worked for her historically.

    Instead of interpreting this wonkiness and progressively lower dosing as a sign that she might be ready to try no insulin, you instead become fixated on how difficult administering small doses is. So, vet approved, you switch to PZI, which is U40, so that you can measure out more liquid, and you use a U100 syringe (with conversion of course) to facilitate larger volume, and presumably more accurate, dosing.

    Upon this switch to PZI 3.5 weeks ago, your vet somehow (I'm absolutely kicking myself here...) talks you into using 0.5 units PZI instead of the 0.1 units Lantus because she knows that (1) they have different formulations for different durations of action and that (2) the insulin proteins themselves have differences at several different amino acid positions and (3) are produced by different production processes.

    For the first week on PZI, you ignore the weird BG because 'hey, her body is getting used to something new.' You catch her pre-shot extraordinarily low (for her) a few times (80 at +12, remember she's normally 250-300 and been doing fine with that for 5.75 years). The next day, you find it at 450, which is higher than you've ever measured her in 6 years!

    Enter the FreeStyle Libre sensor, where you are getting BG numbers in real-time, literally every minute if you want but a minimum of every 15 minutes in the data log. We periodically check with our AccuChek meter and ear pricks and confirm that the FreeStyle Libre and the AccuChek meter we've used for years are measuring the same. (Hooray for the FreeStyle Libre and for the vet's installation of the sensor. It is incredible to have this level of information like a human diabetic would and not have to do any ear pricks, except an occasional doublecheck.)

    During the first week with the sensor (week 2 since you switched to PZI), you witness the same dose of insulin becoming less effective with each subsequent dose. The curves shift higher in BG at all time points and get tighter. You also occasionally observe long periods of flat, high, jagged BGs. You also note sharp falls and sharp rebounds ('bounces' maybe you call them...). You go higher on the insulin and administer with overlap in a cycle to force her back down. It works and drops her into her historic range but the fall and bounce are both crazy fast (100 BG down or up in an hour).

    You come across websites describing the Somogyi effect that seem to perfectly describe all of the various patterns that you are witnessing. So it dawns on you to cut the insulin dose (from 0.5 to 0.4 to 0.3 to 0.25 to 0.2). Even as you walk down to low doses, you see rapid falls and rises like a roller coaster. She starts peeing sweet-smelling, sticky urine in your entryway (not in the litter box in the basement).

    You say to heck with PZI as a failed experiment, it's back to Lantus. It worked for the last 5.75 years just fine. She continues to spray sweet-smelling pee in the entryway (and not in her basement box during these days), though she does use her box for poop. You give the same Lantus dose (0.1 units) that you were doing up until a few weeks prior when you attempted the switch to the PZI. That drops her BG from 500 down to 350 in about +3.5 hours. But it just sits there at 350 for the entire 12 hours. It's flat. Not U-shaped like historic curves. You dose a second time with Lantus at 0.1 units. Again, a drop (from 350 to about 225) and 12 hours of basically flat BGs. You go for the 3rd dose of 0.1 units Lantus at +12. You witness her BG rapidly dropping from 270 down to 50 and see it not leveling off. You observe it hit "LO" (below 40) and spike straight up to 288 only 80 minutes later. She vomits twice during this period and drinks excessively. No seizures. You call ER in middle of night, and decide with person on other end that with no seizing and isolated vomiting to keep her at home and avoid the stress of car and hospital.

    You are terrified to administer insulin after this. Her BG goes "HI" (ie above 500) for 6 hours, and you haven't given insulin in 24 hours. So you opt to dose your most minuscule dose ever - 0.05 units (below zero marking but can still make out a tiny bit of liquid). She drops from "HI" to about 390 within 3-4 hours. But she again does the thing where the BG is very flat for the next 20 hours. This time you waited longer than 12 hours of flatness to see if the flatness went away. It didn't, so at +21, you go ahead and very nervously dose 0.05 units. Eureka - she gives her first normal looking U-shaped curve with a gradual descent to a +7 nadir and a gradual climb back to pre-shot at +14. But her nadir is still high at 190 (reminder: hers are historically 80 to 120 for 5.75 years). So she's spent the beginning and end of the cycle in the 300s and low 400s. You dose 0.05 units again. But then your sensor's 14 days have expired. And both you and your spouse's Holidays are over, and you are back to work all day and can't get any BG readings. So all you have is a +10 of 440 (higher than the AMPS).

    Also of note after all this hyperglycemia and insulin overdosing on the PZI... in addition to sweet-smelling pee sprayed in atypical locations, she has started to shake her front legs out in front of her (neuropathy no doubt). She is thirsty. She is eating about 40-50% more food. And you find her sitting on her haunches staring glassy eyed at times (this is atypical). Her pupils do respond to light. Vet and emergency hospitals don't think ER visit warranted since not seizing or vomiting.

    You discuss all of this data and clinical observations with the vet (who is finally now back from the Holidays) yesterday (Jan 6th) on the same day the sensor stopped. She recommends an appointment with an internal medicine expert, which you make. But the soonest appointment is still 1 week away. She also recommends to stop giving insulin for the time being. You agree, thinking that you misread all of the signs during these past few turbulent months where her insulin dose was coming down and down and pre-shot numbers were wonky. So she has now not had insulin for over 36 hours. All five BGs we've taken during these 36 hours have been 400-440, so seemingly flat but high. FWIW, I have observed no leg shaking (which was prevalent for a couple of days). And she had a kitten-like play session this morning with the laser. However, her appetite is still up. Her thirst is still up. Her peeing sweet-pee in the entryway is still happening. So, the question is...

    Do I wait 6 more days with no insulin until I finally get seen by an internal medicine specialist? (Having dosed insulin every day for 6 years, this is incredibly unnerving.). And if I do dose in the interim, how the heck do I accurately measure 0.05 units? (Anyone ever used a 0.2 to 2.5 microliter micropipettor to aid with this?)

    If I missed all the signs of potentially wanting to go off insulin and instead created a huge horrible overdose storm these past few weeks, will her body gradually rid itself of this sugar? I did buy keto strips this evening and will test for ketones the next time she pees in our entryway.

    I know that was a lot of information. Major thanks to anyone who made it this far. Desperate for any advice. I did mine the data from her FreeStyle Libre sensor and put it into the forum's spreadsheet in my signature block. I have the full data (14 days worth every 15 minutes) plotted in Excel if anyone wants to see it visually instead of in the tabular format.
     
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  2. Juls and Billy

    Juls and Billy Member

    Joined:
    Dec 28, 2019
    I'm a newbie. I can't give you any specific advice. But until wiser and more experienced minds than I come in, I just want to tell you that I'm here and I'm listening.

    I had tagged some members to this thread, but I see that you have a second similar thread, and most of the people I tagged have already responded.

    Stay calm. Yes, high numbers are a concern, but safer than a hypo. If your furbaby has worsening symptoms, you can always take her to the emergency vet. There are so many things that can raise her blood sugar like that. The internist will be of great help, but I know it's scary having to wait that long. I'll be keeping you both in my happy thoughts.
     
    Last edited: Jan 7, 2020
  3. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Linking your other post here, so others can review. http://www.felinediabetes.com/FDMB/...ounds-showing-neuropathy.223961/#post-2505766

    Yes, I read through this entire post and your other one, at least twice in fact, including the comments from Bron and Sheba and Wendy & Neko. They are both very experienced members here. Good comments from them.

    You are in a difficult situation. I can tell how desperate you are to help your cat and so, so stressed out by not being able to just make everything better NOW. Sometimes you can't "make it all better".

    Your vet says no insulin until you meet with the specialist in 6 days. Heartbreaking for you to wait without being able to do anything and you have been treating your cat's diabetes for so long and think "There should be something I can do to make her feel better."

    You can't change the past. What has happened, has happened. You go forward from where you are now and make decisions based on what is happening now, not 6 years ago, or 5 or 4 or.............

    The choice is yours on how to proceed with insulin or no insulin. You hold the needle. You know how difficult it is to measure those micro-doses. You know that lantus does not release all at once, that there is a reservoir or depot that drains slowly over time. The effects of Lantus can last 12-24 hours or more, with one dose overlapping another. TYPICAL dosing for a cat is 2 times a day roughly every 12 hours, but your cat is NOT typical. Myrtlesmum made a suggestion to stretch out the dosing cycle to 18 hours or longer.

    My comments/ideas are:
    1. No insulin raises risks of ketones which can lead to DKA. (infection + decreased appetite + not enough insulin are the typical causes). So glad to see you will be testing for ketones.
    2. Neuropathy usually starts in the back legs, cat walking on hocks but there are other symptoms.
    3. Front leg shaking could be low potassium.
    4. Peeing outside the box could be a UTI.
    5. Sweet smelling urine could be ketones or simply the extra glucose in the urine.
    6. Ketones smell sweet, fruity (like an overripe pear or banana). Some people describe it as smelling like acetone (nail polish remover). If you can't get a urine ketone test with the ketone test strips, smell your cat's breath.
    7. Pancreas - pancreatitis symptoms? or pancreas could be failing to consistently produce insulin (sputtering) or pancreatic cancer.
    8. With everything going well for 5 and a half years and then sudden loss of glucose control, I suspect there is another serious health issue going on with your cat.
    9. What about another Libre monitor? I know they are expensive and only record for 14 days.
    10. Consider micro-dosing once a day or an even longer timeframe as Myrtlesmum suggested in other post.
    11. Do a Quality of Life assessment.
     
    Last edited: Jan 8, 2020
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  4. Dusty Bones

    Dusty Bones Member

    Joined:
    Oct 20, 2013
    No expert here but it almost sounds like Dinah was almost getting ready for an OJT trial in the near future... or maybe not but when per your vet you switched her to PZI it threw everything out of whack. I'll let the experts ring in but you might have to backtrack, reset and set a baseline dose of Lantus and basically start from scratch to get her re-stabilized.
     
    Last edited: Jan 8, 2020
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  5. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
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  6. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Said almost the same thing on your other post that Red & Rover gave you here. That's the problem with having multiple posts going in the same forum.
     
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  7. DinahCat

    DinahCat New Member

    Joined:
    Jan 6, 2020
    Thanks Dusty Bones, Deb and Wink, and Juls and Billy.

    Quick updates on data and clinical observations... I did update her spreadsheet. She basically has been in the high 300s / low 400s for the entire 54 hours since her last 0.05-unit dose of Lantus. I did check her ketones about 30 minutes ago and her BG (374 at +54 hours at 4 hours of fasting). The ketones showed either "Trace" or between "Negative" and "Trace". She is eating 50% more -- about one additional can of wet food in addition to her normal 2 cans (We free feed and have successfully for years because we have another cat and because we're at work or sleeping during her nadirs). Over 36 hours, she drank about 75% of the volume contained in a plastic "beer pong" cup (I add water to their wet food and only see the other cat drink like once a month, so Cat#2's consumption is not a confounding factor, nor should major evaporation). She did return to using the basement litter for urinating and not the front entryway. The pee still smells sweet but not like acetone. She has had kitten-like laser play sessions each of the past 2 days. Haven't noticed any glassy-eyed staring, but I am back to work after the Holidays, so tough to know for sure.

    Finally, I haven't witness any of that really odd leg shaking for the past 48 hours. (I hadn't heard of the low potassium hypothesis. I figured her front legs were either hurting or numb/tingly from the several weeks of very high BG. The behavior she was doing is what I would do if a limb was "asleep" -- I'd shake it out really good.)

    @Dusty Bones - My gut is telling me what you said. And, you and Deb and Wink are both right - have to proceed forward with the most recent data and try to re-establish some baseline. And Myrtlesmum is living the same situation I have been and made a great suggestion. Dinah was actually on 0.1 units Lantus every 15 hours prior to the crossover to PZI. The longer period was a safeguard for the accuracy issues with the micro-doses and the fact that we're typically working or sleeping during her nadirs.

    Decision - I dosed her today with 0.05 units after 54 hours in the high 300s and low 400s and (possibly) some "Trace" ketones. I don't have time to wait for vet's office to call back, and I know my cat.
     
  8. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Knowing your cat is very important. You are there to observe and we can only know what you tell us. ECID as we say here, Every Cat is Different, Every Caregiver is Different.
     
  9. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Thanks for filling in the spreadsheet with the last couple days of tests. First of all, Dinah still needs insulin. Her numbers are far too high without insulin. Second, Dinah's spreadsheet and Myrtles (what we can see cause the last six months are blank) look nothing alike. I don't even think Myrtle should be dosed the way she is. But that's nothing to do with Dinah, just means you shouldn't use her as an example of how to dose Dinah. Dinah's problem is that she has hardly any duration. Plus she isn't used to normal numbers because you have been dosing to keep her in higher numbers, which her body has become used to. Check out this post on glucose toxicity.

    I see the spreadsheet shows Trace ketones. That's another signal she really needs insulin. Side note, has she been checked lately for UTI? That could cause the pee issues and adding infection to the picture really means you need to get insulin into her. It may mean you feed her slightly higher % low carb so you can get insulin into her. In the mean time, continue giving 0.05 units, and I would do it every 12 hours. If she starts going lower than you are comfortable with, start looking for some 8-9% carb options.

    By the way, Symogyi is not a thing. The original study years ago was done on humans and fast acting insulins. Here's a description of more recent research, done on cats.
     
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  10. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    I don't even know what a "beer pong" cup is.
     
  11. DinahCat

    DinahCat New Member

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    Jan 6, 2020
    Deb & Wink, I know - sincere apologies on the double-post. Please forgive a newbie. Won't happen again. I was in a panic on the first post and thought I could re-state it more coherently.

    Quickly on the micro-dosing... I love all the suggestions. I actually feel reasonably confident drawing the dose and being consistent. And no bubbles ever for sure. Where my anxiety comes with regarding such small doses is the during the injection itself as it pertains to that little bit of residual liquid that stay in needle itself after you inject (I call it the "dead" volume, but maybe there is some forum term for it).

    If I push a hair too hard on a given day. Or if she moves a bit and her tissue draws in some more fluid from that which would be left in the needle by a capillary effect. That little bit of liquid that stays in the needle is significant relative to a 0.1 dose (which is what I call when I use the "0" marking on the syringeg). That needle liquid is about 40% the volume of the 0.1 dose. I've checked before using a micropipettor (I worked for year's in a life sciences R&D lab and now run one). So that is a significant boo-boo if some extra fluid gets dosed. Also syringe lot to syringe lot show variations in those markings. I'm sure
     
  12. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    So true, that's why many of us moved to digital calipers for measuring the dose. For quite a while, Neko's dose was under the zero line because the line markings were so bad on the batch of syringes I had. I figured it was actually closer to 0.25 units of insulin.
     
  13. DinahCat

    DinahCat New Member

    Joined:
    Jan 6, 2020
    A plastic cup like you'd have at a family picnic for beverages.

    Thanks for tip on higher carbs. That's always been on my mind as way to grapple with micro-dose anxiety. I'll discuss with internal medicine person on Monday.

    Looking for terminology on the following types of curves to help facilitate searching past posts for similar stories...

    If not "Somogyi," what is the semantic term to call the phenomenon of rapid fall to lower than normal numbers (for the cat) followed by spiking/rebounding/bouncing (whatever the forum's jargon for the BG rise post-nadir is) to very high numbers? Sort of like a check mark shaped BG curve (instead of a nice U-shaped one like I'm used to seeing).

    And/or when you use the same dose of insulin for several cycles in a row, but you see the whole curve shift up to higher BGs and shift up to still higher BGs with each successive dose. So then you apply more insulin to force things back into the "normal range," but the cat throws you a curveball and drops ultra-fast to below 40.

    This was the stuff that was going on during her shift to PZI about 3 weeks ago. That's why I went back to Lantus, which is what she has used (very successfully) for essentially 6 years. The switch to PZI was because micro-dosing became very challenging and nerve-wracking. TR is a new concept to me, but Dinah has been just fine for 6 years being 250-300 at AMPS and PMPS while riding along at 80-120 during +3 to +9. Her max dose ever has been 1.0 in those 6 years, and that was years ago.

    Thanks again to all.
     
  14. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Syringe lot to lot do have variations in the markings on the syringe barrel, which is why some people use calipers for dosing. Insulin pens can also vary in how much insulin is delivered with each shot. We do the best we can to be consistent. Some people draw up some colored liquid in a 'reference syringe' and put the syringes side by side to compare. But would think you would need to make a new 'reference syringe' as the liquid evaporates.

    I've read studies that say it's nearly impossible to accurately and consistently dose under 2 units with a U100 insulin (children and toddlers). Yet we need to do measure and give those tiny doses all the time with our cats who are usually even smaller than human children. "shortcomings in the accuracy of syringes and insulin pen devices at small insulin doses have long been recognized". Link 1 Link 2 Link 3 Link 4

    Have you thought of shaving a small patch on Dinah's fur, where you give the insulin injection? To see if any of that already tiny dose is leaking back out? Not sure it will help at all. Just a thought. Brainstorming here.
     
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  15. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Rapid onset, caused by a bounce. Some cats just like to drop hard and fast. Unfortunately fast drops can also cause bounces. The way to control that is to find out when her onset is, and what part of her cycle she likes to drop a lot, then preload her with food so she has fresh carbs on board when the insulin onsets. If you feed too many carbs after nadir, you can also cause duration to be shortened, causing her to spike at preshot. The insulin is waning after nadir and adding carbs then can put the brakes on the insulin action. High preshot means possible big drop, and around you go again.

    Start tracking when and what she eats, how much and carb %, and see if you can find any cause and effect. Note that different cats have different carb sensitivity. What works for Dinah might not be the same as for others.
     
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  16. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I agree with everything that Wendy has said in this thread.
    If there are any ketones in the urine, then insulin needs to be given.
    I don't think Dinah is near remission and she needs to be given insulin each 12 hours. As Wendy said, Dinah is not used to being in lower numbers now and any time she drops into them she bounces.
    You can help with this by feeding at onset or when she drops fast, as Wendy suggested, and using some higher low carbs, around 8-9% which will help stop her dropping so low. My Sheba liked to drop fast and then bounce and I found the way to help stop that was to find out when she dropped and then feed her before that, so that she had some carbs aboard to counteract the big drops. It is a bit of trial and error at first but it does work.
    Both Wendy and I have mentioned getting the urine checked for a UTI and it would be very worth while to do this. If there is any infection there, it needs to be treated.

    If I were you, I would reread all that Wendy has written and make notes of it and follow what she has suggested. She is very experienced and I would trust her with all my cats.

    Have you taken any BG tests since you gave the insulin dose at the PMPS?
     
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  17. Myrtlesmum

    Myrtlesmum Member

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    Apr 13, 2017
    Dinah’s numbers are higher than Myrtle’s were but the situation sounds similar. I don’t fill out the spreadsheet anymore (I keep my own) because there is way too much “dose shaming” on this board by people who really know nothing about my cat or me but “think” they know everything and feel the need to check out my spreadsheet and make comment even if no advice was sought regarding dose. Myrtle is happiest and healthiest than she has been in a long time with her numbers constantly in the blue or green. My vet marvels at how well Myrtle is doing. Every cat is different.
     
  18. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Dec 28, 2009
    @Myrtlesmum - I will repeat what I said previously. it would be helpful for everyone to be able to see what you've been doing with respect to your managing your cat's FD if you are going to be offering suggestions to caregivers. You've no longer linked your spreadsheet which makes it very difficult to take your suggestions at anything other than face value. Personally, I'd like to see the data as there's something I may be able to learn. OTOH, you seem quite comfortable making all sorts of suggestions about someone else's cat who may, in actuality, be very different than your cat. Additionally, you want to take issue with what others are saying. I've been around here considerably longer than many people and I've not experienced or observed "dose shaming." I've seen people offer well intended suggestions or try to teach. Perhaps that is not how you experience people's input and I absolutely acknowledge that writing out information may not be perceived in the manner it is intended. My personal feeling is that if you are going to be dispensing information, you need to have a spreadsheet linked to your signature so people are able to evaluate for themselves any similarties, differences, or the outcomes of your ablity to manage your cat's diabetes.
     
  19. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I agree with Sienne 100%. I suggest to members that if someone is giving dosing advice and that person does not have a SS linked, the member should think twice about taking their advice. I also have not seen dose shaming here but it’s pretty common knowledge that if you are going to post in a forum, you need to have thick skin because the written word often sounds a bit harsher than the spoken one. And really, no one can make you feel shamed but you. If you know your cat and you know what is best for her, then it just takes a simple “thanks but I know what I’m doing with my cat”.

    We are pretty good at thinking outside the box here; that means when we look at a SS, we might very well offer an alternative opinion on what might help the cat. If a member doesn’t want to take it, that’s all they politely have to say. The member holds the syringe. Jill helped us very closely for a long time and sometimes we did not take her dosing advice because we knew Gracie. She was very cool about it and I appreciated that. We are thrilled that Myrtle is doing so well.

    Sorry for the thread hijack.

    @DinahCat I would probably get started back with 0.1u twice a day and see how she does. Stay on top of the ketones; record foods, etc like Wendy suggested. If you can get random spot checks, we can help you know if and when the dose needs to go up.

    In actuality, from the Freestyle Libre, she was doing fine on 0.5u; those numbers are not too low for a human meter. In the past and even on the German forum board, many members allow their cats to “surf” flatly in the 40s. Even I did for a bit with Gracie. Unless you are seeing real symptoms of a hypo other than sleeping hard, I’d likely not call it a hypo. For most cats, the numbers have to be much lower for a symptomatic hypo. I thought I read (other thread maybe) that you tested her and she was at “LO” but I don’t see that on the SS anywhere.

    Actually, her numbers and cycles do not look that different to me from most diabetic cats. Hang in there! I do believe it will get better.
     
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