Yikes, numbers too low??

Hello, I am Dante's mom and he is is a 6 year old cat diagnosed about 4 weeks ago now. He is still not regulated with his insulin yet, so the vet still has him on 2 units of Lantus.

Every Sunday, I do a BG curve and this morning at 5:30, before his 2 units of Lantus, his BG was 197. He ate his breakfast and I gave him his 2 units. Now, 3 hours later, I just drew his blood and he is at 65(!!). I just called the emergency room and am waiting for a response back, though it may take a while as they are dealing with an emergency. He is not dispalying any symptoms of a seizure in any way, in fact, he has been running around and I have been playing with him and his feather all morning. When I stop, he drags it back to me, so he can play more. Can anyone offer any advice? I understand the normal range in 140-180...thank you for your help!

 

Hmm, am I on the right forum, this is the first time I have ever joined any forum, and I only did so as I nearly lost my cat 3 days after his diagnosis. I must be in the worng place. For anyone interested, the emergency room called back rather quickly, (the last time is took almost 6 hours for a repsonse as they had another emergency at the time, which I why I frantically wrote to the forum. I was told to put Karo syrup on his gums and not give him his injection tonight. I guess I am in the wrong place??

 

Hi,

Yes, you're on the right forum. What is your most recent test result? (Just going to re-read your post).

 

Do you have food in gravy available? If so, you can give a couple of teaspoonfuls of the gravy.
Otherwise a couple of teaspoons of ordinary food with karo added.
If he will eat by himself then you shouldn't need to put karo on his gums at this point.

 

I would also suggest that you ease off on the playing for a while, as we don't want him burning off more glucose right now.

 

Do you have a more recent test result that that 65?

Incidentally, the normal range for a kitty is roughly 50 - 130, so the 65 is OK, but we don't want Dante dropping much lower, and he still has quite a way to go until the peak of the insulin cycle.

 

whew, Thank you for your response, I was able to rub the Karo on his gums, and he didn't seem too happy, but he licked it off. I will remember the gravy food if this happens again, thank you! If I sound frantic, I am, I'm sorry. I posted an introduction earlier this week, as this is all very new to me. 3 days after Dante was diagnosed, due to incorrect instructions on how to read the markings on the syringe, I was instructed to give 20 unit instead of 2 units. After the third injection(60 units), Dante went into a full-blown siezure, and as soon as I realized he was in danger, he was in the hospital 20 minutes later. So, now, unfortunately, everything scares me. While he was in the hospital, I unfortunately learned the symptioms of a seizure after doing extensive research on the web. I didn't expect to witness it so soon after his diagnosis. I will check his BG again in 3 hours and hopefully it will have gone up. Thank you for your time in responding.

 

No, I have not done another BG, my hands are shaking so much right now, I would probably jab him way too many times, so I will wait until I calm down, for his sake and mine!

 

OK, but please do check it as soon as you can.

Do you have any higher carb food that you can give him a spoonful of? Since you can't check him right now it would be good to err on the side of caution and get some food into him.

Glucose/syrup acts fast but wears off fast too. Food takes longer to raise the BG but is active in the system for longer.

You may need to monitor over the next few hours and keep bringing the BG up if it drops too low.

Please see this info from the Lantus sticky on how to deal with low numbers:

"If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

• 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) 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.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe."

 

I know you're scared, but it's OK, you can do this.
Take some deep breaths. (And here's a reassuring (((hug))) for you)

Most episodes of low numbers can be handled by feeding small amounts of food and/or giving syrup (as appropriate), then monitoring the kitty's BG, and repeating the food or syrup as necessary.

If however, you see the numbers getting too low and you don't feel you can deal with the situation at home, then do consider taking the kitty to ER. It's always your call. But most low number situations can be managed at home if the caregiver is comfortable to do that and has the time to be able to monitor.

Does Dante have any other health issues apart from the diabetes?
.

 

Understood, I am surprised that I can even type right now; I will check his BG after I give him some of the high carb food that I bought before he was diagnosed, thank you!!! I saved your instructions to a word doc as this is very useful information, thank you!

 

Okey dokey,
Just give a little bit of food (and just gravy if it's an 'in gravy' type food) in case you need him to eat more later. We don't want to fill his tummy up too much.

 

FYI, I've posted a link to this thread in the Lantus forum to catch the attention of other Lantus users. (There should be more online soon)

 

Whew, thank you for the hug, I needed it! When he was hospitalized his BG registered at 37, so yes, 65 scares me! I just gave him some Friskies gravy sensations. He has been on Science diet from the time I rescued him at 4 months old, and for 6 years has eaten Science Diet dry. I bought the gravy sensations as prior to his diagnosis, he was constantly thirsty, so I thought the gravied food would help. I didn't think it would be this handy though! My photo of Dante shows him at at 4 months old, I should update it, as he is 6.5 years old now. I will take his BG now...

 

Ah, got it- about the gravy - thank you No, he doesn't have any other health issues, sorry, thank you!

 

You're using a human meter not an alphatrak, right?

 

Good question...

 

Yes, the vet told me that the Relion brand is good, so I am using the Relion Prime, I just checked his BG, he is now at 119.

 

First.... deep breath.

There's a big difference between low numbers and symptomatic hypoglycemia. A 67 is a lower number and is in normal BG range. In other words, taken in isolation, it's not a dangerous number. My kitty has had numbers in the 30s and once you know what you're doing, it's not an emergency situation unless, like you experienced with Dante, there were symptoms of hypoglycemia.

We have instructions for Lantus and Lev users on how to handle low numbers. You might want to print these out so you have them on hand. The basic idea is to test every 15 - 20 min and feed in order to keep numbers in a safe range.

It would also be very helpful if you could create a spreadsheet for Dante. That will also you and us to track his progress and we will be able to offer more help if we can see his numbers.

 

Good! On a human meter, 50 is the number where we start to take strong action. He's completely safe now. Don't be surprised if he bounces up high now. Going into normal numbers when the cat isn't used to it can do that. You're doing great!

 

I just checked and can buy the Alphatrak from Amazon...I bought a 100 pack of test strips for the Prime, is it all-right if I use up the 100 strips before purchasing the alphtrak, or would you suggest I buy it now?

 

You don't need to get the Alphatrak (well, unless you really want to!). A human meter is fine, and a lot cheaper to use. Most of us use human meters.
It's just important to know if someone is using an Alphatrack because it reads differently to human meters.

 

I wouldn't recommend the alphatrack. The strips are crazy expensive. It's just important for everyone to know which meter you are using, because the numbers run a bit differently. If you add "relion confirm" to your signature, that would be super helpful.

 

Be sure you test again about an hour after your last test. You want to make sure the carbs don't wear off. He could go back down again, which would mean he'd need more food. It would be good to post your next test number.

 

Wow, thank you all for your support; Dante was crying incessantly while his numbers were down, I thnk it brought bad memories for him. Even my son asked why Dante was being so vocal, and I burst into tears. I know, a bit emotional, due to my being in uncharted territory. He is now quiet and resting on his blanket on my computer table, he knows he is better...I can breathe now, thank you!
I read your instructions, and yes, Dante had displayed every single symptom wihtin a 5-minute range, it happened so quickly; however, after speaking with the doctor, there were earlier signs that I was not aware of, due to my being a novice. Talk about alarm! On a better note, it was so heartwarming when I brought Dante home from the hospital, my son's cat, Seymour, has seen him fall earlier as he couldn't stand in his litter box. Seymour immediately went to support him the first time Dante used the litterby pressing his head against Dante's shoulder while he was in the litter box, in case his hind legs couldn't support him...wow! I was afraid that Seymour might topple Dante down, but Dante accepted his kindness and licked his forehead, ugh, waaaay too cute!
Thank you for explaining about the low numbers without symptoms, once again, swimming, er, rather, drowning, in uncharted territory, ugh! Thank you! Ok, so, I will check in one hour. It is good to know there are expereinced people out there so willing to help, especially so early on a Sunday morning, thank you! Yes, I will write emergency or 911 in the topic when necessary; however, I won't be so frantic next time. You all are the BEST, thank you so much, you have NO IDEA how comforting it was to interact with someone during a dire situation, for me that is!
I saw the spreadsheet, wow, that is great, how do I access this spreadsheet and are there instructions for creating one? Thank you!

 

As you can see there is lots of support for you both here!
I have found these wonderful folks know more about feline diabetes than the vets do.
Just wanted to welcome you both and hope you get a spread sheet going.

 

That must have been terrifying! Seymour sounds like a sweetie pie.

Frantic was my middle name when I started out. Not only did I panic when Mikey's numbers were low, I freaked when they were high or normal. There's just so much to take in at first. It's overwhelming. I'm not an experienced board member, so there's a lot I'm not able to help with. One of those things is setting up a spreadsheet. I'm going to tag @Marje and Gracie here. Marje is the Spreadsheet Queen! Meanwhile, write down all of your numbers, so you'll be able to log them in later.

 

Yes, INCREDIBLE!!! After I spoke with the emergency room receptionist, who conferred with the doctor, I stated that I will do another BG in 3-hours and she agreed...It wasn't until I corresponded with Elizabeth in this forum, that I was informed to test much sooner, thank you(!) and therefore greatly reduced the amount of time I was stressed out. Dante is no longer crying as he is now asleep with his arms above his head...er, rather, paws above his head...THANK YOU!! Thank you for the warm welcome and yes, I do need to start a spread sheet.

 

Please send me a private message if you have any issues with creating s spreadsheet.

To send me s private message, click on "Marje and Gracie" under Gracies photo and then click on "start a conversation".

I'd be happy to help

 

Mary, Hah, my middle name is "scared and frantic", so I hear ya'! It is overwhelming; however, I am glad you wrote so I know I am not alone, thank you! Yes, I am changing vets so I have logged all my results on an excel spreadsheet; however, this spreadsheet is much more comprehensive,

 

Marje;
Perfect, thank you for the link, I will create a spreadsheet today, thank you for your offer of help though, hopefully, I won't have to take you up on it!

 

Welcome to this wonderful forum Dante's Mom the members of this board are extremely generous with their encouragement and advice. Last night one of them was up with me half the night giving advice and support, I was so scared for my Lulu, but all is well today. Also, I am becoming very proficient at home-testing, learning about proper diet for diabetic cats, it's just unbelievable how much you will learn. You'll love it here

 

Wow, I wonder if we're related.

 

I just tested his BG, he is at 223, would I still need to give him his Lantus tonight, if the numbers stay above 200? The Emergenct vet said to monitor and skip the 2 units of Lantus tonight, do you agree?

 

Wow, that is pretty cool; I can easily see someone doing that, as they just supported me early(!) on this Sunday morning. I too, learned about the diets here and just learned volumes today! This is the first forum I have joined, I am so glad I did!!

 

You want to get dosing advice from the experienced members, which I'm not. If you wouldn't mind posting in the Lantus & Levemir forum, that would get you some good advice. Have your subject like look something like this:
4/12 Dante AMPS #, +# 67, +# 223 New member needs dosing advice

Just fill in the numbers where I used "#".

 

One other thought, you will want to state his weight in your post. That can make a difference in dose.

 

Lets see how he is tonight. He may bounce - when the glucose level drops quickly and/or drops to an unfamiliar level, compensatory hormones release stored glucose (glycogen), This brings the glucose back up and even higher for up to 3 days.

How much does he weigh?
How much should he weigh?
Convert to kilograms (that is pounds / 2.2)
Multiply by 0.25
Round down to the nearest 0.25.
And that gives you a starting Lantus dose.

Note: because of the previous overdose of 20 units , he may be more sensitive to the insulin.Home testing may show that.

 

Mary;
Thank you for the advice, I did post it there, thank you!
BJM;
Thank you for your prompt response, I believe he is currently at 11 pounds. He was weighed 4 weeks ago in the vet's office and hospital and had lost 4 pounds from his previous annual office visit in 2014. Since his return from the hospital, he has gained weight and looks healthy now. The doctor said he could stand to lose 1 more pound though. His previous overdose was actually 60 units as the tech gave him his first dosage of 20 units and I gave him 2 more dosages of 20 units each, before he displayed seizure symptoms.
Ah, thank you, the result of your equation equals 1 unit as the starting dose, got it, thank you. Ok, I will test him again at 3:00 for his curve and the last one will be 6:00pm tonight. Your explanation confirms the emergency vet's advice to skip the insulin; wow, I have learned so much from this forum! This morning, I was too frantic to think of even asking him why I should skip the dose, thank you for the explanation!

 

Also see my signature link Glucometer Notes for info on feline-specific reference ranges (no math required!)

Once you start using our grid to record your glucose tests, it will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

Wow, I had viewed someone else's spreadsheet and was quite mystified as I haven't had a chance yet to read the key chart and instructions, so thank you for telling me in a nutshell! I am taking Dante to a new vet this coming Saturday, so I will present the completed spreasheet to her and I am sure she will be impressed! I have been on this forum since 8AM as Dante's low number threw a curveball when I wasn't looking! I have to run a few quick errands before his next BG at 3:00, so after that I will start the spreadsheet. THANK YOU!!!!!