Unusual Low numbers - Dosing help needed

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amy keay

amy keay

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Hi

My cat sooty has been doing well - I’ve been testing bg regularly (at least pre shot levels) and we’ve been in the 20’s and he’s been getting 2u if caninsulin.
Recently, (the last few days) we’ve been getting odd numbers.
He was 7.6 am pre shot on Tuesday and therefore we skipped the shot. The night before his pre shot was 22.5 so he had his normal 2u.
I’ve reduced his dose to 1.5 the last few days and yesterday his am pre-shot was 15.8 and at +6 was 4.6, +6.5, 4.9, +7.5 7.6.
last night his pm Pre shot was 21.4 so he had his 1.5. This morning we are at 15.8.
my question - why have his bg numbers suddenly appeared to go down ? he’s fine in himself - maybe a bit more sleepy than usual but that’s it.
Also, how often should I be changing his dose ? At 15.8 am I ok to give 1.5 u ?
Help please
Amy and Sooty xx
 
Just given 1.5 u and will do a curve today and get some bg levels for +2, +4, +6 and see what they say

x
 
Amy I am sorry no-one got to answer you earlier.
I have just been looking at your SS
I have not used Caninsulin but I will tag someone who can help you with the dosing
@MrWorfMen's Mom
I am glad you are going to do a curve today.
If you can I would suggest you always get a before bed test at night to see how Sooty is. A lot of cats drop lower at night so a before bed test will tell you if he will stay safe. If the before bed test is lower than the pre-shot, then you may need to test again.
Also if you can get a +3 or +4 in during the day, that will tell you how he is managing the insulin.

Are you giving him a snack of food around the +4 mark?
 
Hi
He normally grazes food all day (little and often). I don't tend to give him a specific snack at the +4 Mark..
In all honesty I do try to get him to eat something at around the +2 time to potentially slow down the drop ?!?
I'll be testing every 2 hours today and will update the ss with the results.
When we had the amps of 7.6 a few days ago it's completely thrown me and I'll panicking again. He seems ok in himself though and at least we're not in the high numbers.
I have food with gravy and honey at home ready in case he drops too low x
 
amy keay said:
Hi
He normally grazes food all day (little and often). I don't tend to give him a specific snack at the +4 Mark..
In all honesty I do try to get him to eat something at around the +2 time to potentially slow down the drop ?!?
I'll be testing every 2 hours today and will update the ss with the results.
When we had the amps of 7.6 a few days ago it's completely thrown me and I'll panicking again. He seems ok in himself though and at least we're not in the high numbers.
I have food with gravy and honey at home ready in case he drops too low x
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Amy your feeding plan sounds good. Feeding at +2 is a good idea.
Does he eat well before the insulin?
@MrWorfMen's Mom who I have tagged will be able to help you with the dosing and if you need to reduce the dose.
 
+2 16.4 - happy with this I think !?
He’s just had a bit of a munch too at the +2 point so that’s good too (I hope !)

Next test at 10.30
Will update ss now

a x
 
Ok - time to potentially worry - +4 and we have 4.3 ? I know caninsulin is fast acting but this isn’t great.
he’s hungry so I have given him some food and I’ll test again in 30

any ideas what’s going on !

a x
 
Amy, 4.3 is a safe number but you need to keep a close eye in case Sooty goes lower, I would suggest testing again to be sure and have your HC food ready just in case.

To add: I am in now way an expert, I can just see that no-one else is online at the moment and didn't want you to feel completely alone x
 
Thanks for the reply.
I'm actually at the vets cos I panicked.
I'm worried that if I wasn't at home to give food he would have continued to drop.
Also worried that he dropped too quickly (4.3 at +4 seems too low
X
 
I'm sorry I wasn't online when you posted.
Please let us know how Sooty is.
If he drops again like that quickly, give him some high carb food or honey amd test again 20 minutes later.
4.3 is a safe number but probably lower than it should be when using caninsulin.
Do you have some high carb food at home for low numbers?
 
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Hi

I gave him some pate as food after the 4.3 reading (i think it's high carb).
Worried that if I wasn't at home though to give the food we would have been in trouble! He shouldn't have dropped that quickly and I don't know why ?
At vets - he's having his blood tested now and just waiting.......
 
amy keay said:
Hi

I gave him some pate as food after the 4.3 reading (i think it's high carb).
Worried that if I wasn't at home though to give the food we would have been in trouble! He shouldn't have dropped that quickly and I don't know why ?
At vets - he's having his blood tested now and just waiting.......
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I think he probably needs a reduction in dose. As I said earlier, I have never used caninsulin but I have seen others say that they don't like the nadirs to be lower than about 7. edit ....lower than 5
Pate is usually low carb
There are other more suitable insulins for cats such as Lantus or Prozinc which are longer lasting and more gentle. You could ask your vet to swap the insulin to one of those.
 
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Hi Amy
You're right, that's a very steep drop in only two hours. I can understand why you panicked. As the others have said, if it happens again you can try giving honey or a high-carb food, which should halt the drop, but keep testing until bg is clearly rising. On this occasion it was probably a good move to take Sooty to the vet where they can keep a close eye on him. While you're there I would definitely discuss an alternative insulin with the vet - Caninsulin can and does work, but its action is not always ideal.

Best of luck.
 
Hi

I already have prozinc at home and I'm ready to swop over.
Is this the best time to swop though with bg dropping too quickly? Is it better than caninsulin ? Or just different? Is it slow acting ?
I remember reading that caninsilin is fast acting and may be if prozinc is better I move over to that?
 
I'll discuss with the vet moving over to Prozinc and see what they say.
Are there issues with prozinc that I need to know about before switching?
 
amy keay said:
Hi

I already have prozinc at home and I'm ready to swop over.
Is this the best time to swop though with bg dropping too quickly? Is it better than caninsulin ? Or just different? Is it slow acting ?
I remember reading that caninsilin is fast acting and may be if prozinc is better I move over to that?
Click to expand...

I would speak to the vet about the best time to switch - let Sooty's bg stabilise today, take him home where he's not so stressed, and see what his next pre-shot is.

Prozinc isn't necessarily "better" than Caninsulin - the best insulin for a cat is the one that works for the individual cat. But Caninsulin is not ideal for many cats. It was intended for dogs, who have a different metabolism. Caninsulin usually has a fast "onset" (ie starts to work quickly), a shortish "duration" (how long it is effective for) and a "nadir" (lowest point) rather earlier than ideal. Prozinc works in a gentler way so the curve shouldn't be as steep - more of a gentle "smile". But again, nothing is certain so you need to try it and see how it works in Sooty. It may well be better if it slows down drops like the one you've seen today.

So my suggestion is to ask the vet's advice and also, if you haven't already, read the beginner's guide to Prozinc - it was updated a couple of years ago by a group of us here and is fairly comprehensive, I think. Oh and also read up on the Prozinc forum of course, and post insulin-specific questions there.
 
Thanks for that.
I'll do all that you say and see what the vet says.
Also, i would want to be at home the 1st few days on prozinc to make sure all is ok.
I'm guessing we start low and do a curve and see what that shows? And then increase gradually if needed?
 
amy keay said:
Thanks for that.
I'll do all that you say and see what the vet says.
Also, i would want to be at home the 1st few days on prozinc to make sure all is ok.
I'm guessing we start low and do a curve and see what that shows? And then increase gradually if needed?
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Yes - start low and keep a watchful eye and get a few tests in when you can to check onset, nadir and duration. It should be better. When you start to see a pattern you can tweak the dose as necessary.
Let us know how Sooty gets on today and what the vet says.
 
Leaving vets now. They gave a 3 day antibiotic injection (his teeth are bad) and said on physical examination he was ok.
Said to keep on 1.5u and monitor. Not to switch to prozinc just yet until bg stable.

On a separate note, the UK foods spreadsheet - I should be on a low carb food- is that one with a low % of carbs in (in the yellow column ). He wouldn't eat whiskas for a few days so I swapped to Felix- would that have made a difference?
 
amy keay said:
Leaving vets now. They gave a 3 day antibiotic injection (his teeth are bad) and said on physical examination he was ok.
Said to keep on 1.5u and monitor. Not to switch to prozinc just yet until bg stable.

On a separate note, the UK foods spreadsheet - I should be on a low carb food- is that one with a low % of carbs in (in the yellow column ). He wouldn't eat whiskas for a few days so I swapped to Felix- would that have made a difference?
Click to expand...

So the vets think Sooty might have a mouth infection if they're giving him antibiotics? Infection can raise bg so when the course of abs is over, keep an even closer eye on him as he may need less insulin if he's not fighting infection. Abs themselves won't cure bad teeth though so if they're that bad you may have to consider a dental.

Whiskas and Felix are usually pretty comparable carb-wise. Make sure you get the versions in jelly, not gravy.
 
The vets said that his teeth were bad (which I new anyway and he’s had bad teeth for a while).
The bg levels don’t indicate an infection though ? I said high bg indicates infection ? But the vet said low bg can also indicate infection ? It’s a 3 day antibiotic though and not a 2 week one so we’ll see how he goes.
depending on his PMPS will I guess determine whether he gets 1.5u or not. Is it worth dropping to 1,25 u based on the 4.3 reading we had today and the fact that he might drop lower at night ?
Yep got the felix in jelly which I mix and match with Waitrose and whiskas and whatever he will eat at the time.
 
High bg can indicate infection yes, not so sure about low bg also but I've read here about another vet saying that. Low bg is usually caused by too much insulin, so the low numbers you've seen today could just be that Sooty didn't need that dose this morning. Insulin requirements can vary by quite a lot, sometimes for no apparent reason. Sometimes an unexpectedly low number can mean that the pancreas is producing some insulin of its own.

Yes I'd be inclined to be cautious with dose this evening - post here with his pmps and ask, if you're unsure. There are usually more people around at that time of day.
 
That’s what I thought too. His bg levels if anything are lower than normal rather than high and I thought infection brought on high bg levels.
will the antibiotic injection have an effect on the bg levels ? I’ll be doing a PMPS so I’ll post later and see what response I get.
It’ll be about 5.45 ish so if you’re around look out for my message please x
 
The antibiotic injection shouldn't have any effect on bg unless it causes stress of some kind, and I don't think it should.
I'll look out for your update nearer pmps time, but I'm not one of the "dosing experts" here so you might like to start a new thread with something like Caninsulin Dose Help Needed in the title, and/or post on the Caninsulin forum as well. Keep your ss up to date for day so people trying to advise can see what the situation is.
 
Thanks Diana - will do !
He seems fine at the moment, although not that hungry.
hopefully he’ll want some food a bit later
Will obviously do the PMPS 2 hours post any food

x
 
Hi Amy, Just seeing Bron's tags now.

I see you recently reduced Sooty's dose from 1.75u to 1.5u. Not sure why you reduced but glad you did.

Vetsulin often causes swift drops in BG and some cats reach their nadir (lowest point in the 12 hour cycle) as early as +3 hours post shot. From the data you have it looks like Sooty might be reaching peak action around 4 or 5 hours post shot but you don't have a lot of data so that is just a guess.
Dropping to 4.6 mmol(83 US) on the 7th and then to 4.3 mmol (77 US) on the 8th, I'd be inclined to drop the dose back to 1.25u now and see how that works for Sooty. Because of the sharp quick drops Vetsulin can cause, it's best to aim to have kitty not drop much below 5 mmol (90 US) so that if they are dropping, you have time to take action and keep kitty from dropping too low.

Low BG can occur with infections but that is far rarer than elevated BG. Not sure what antibiotic shot vet gave that is supposed to last 3 days. I wonder if it was Convenia which exerts antibacterial effect for 1 to 2 weeks. Given Sooty's age, they may be reluctant to put him under anaesthetic to do a dental. In those cases, they will sometimes prescribe pulsing antibiotics and offer some pain medication to control any discomfort the dental issues might be causing.

You've done great getting mid cycle tests during the day for the last couple of days and I understand it can be difficult to get mid cycle tests every day if one is working or has other commitments. Try to get mid cycle tests at every opportunity so you can see exactly how much BG is dropping on any given dose.

I'd also encourage you to get some night time data. Our kitties have a habit of going lower at night than they do during the day (another reason to drop the dose a bit now) and with no testing at night you are missing half the picture of what's going on with Sooty. Obviously we all need our sleep, but we recommend getting a test in +2 or +3 post shot and at minimum at least a before bed test every night. That way if Sooty is dropping quickly, you can take action early and keep him from dropping too low. This particularly important when there may be an infection at play that can cause swings in BG.
 
Thank you for the advice - much appreciated.
The PMPS is normally back in the 20’s which is why I’ve been giving the 1.5u at night but as I’m getting low amps readings it may be that the 1.5u (even with a pm pre-shot of 20) is too much for him.
I will be doing the pm pre shot at about 5.45 this afternoon (he normally gets his shot at 6.30) and report on here and my ss.
I am also inclined to give 1.25 as he certainly doesn’t eat a lot at night (he’s awake most of the day) and asleep at night. I’ll also try and get a +2 and +3 reading before bed time.

The vet suggested dental work about 6 months ago but because of his age and the fact he is still eating without any major discomfort I decided not to put him through it. He’s got a bit of a chequered history and my neighbour thinks he might actually be about 22 years old !

he’s snoozing at the moment so hopefully he’ll wake up hungry as I want to make sure he’s got food in him for the shot.
As a side issue, (sort of) he can be a fussy eater and we change from Felix to Whiskas, to Pate, quite regularly. I suspect that this may be an issue too and I probably need to consistently be giving him the same ? - welcome any thoughts on this as I obviously need him to eat so whatever he wants that day he kinda gets !!



MrWorfMen's Mom said:
Hi Amy, Just seeing Bron's tags now.

I see you recently reduced Sooty's dose from 1.75u to 1.5u. Not sure why you reduced but glad you did.

Vetsulin often causes swift drops in BG and some cats reach their nadir (lowest point in the 12 hour cycle) as early as +3 hours post shot. From the data you have it looks like Sooty might be reaching peak action around 4 or 5 hours post shot but you don't have a lot of data so that is just a guess.
Dropping to 4.6 mmol(83 US) on the 7th and then to 4.3 mmol (77 US) on the 8th, I'd be inclined to drop the dose back to 1.25u now and see how that works for Sooty. Because of the sharp quick drops Vetsulin can cause, it's best to aim to have kitty not drop much below 5 mmol (90 US) so that if they are dropping, you have time to take action and keep kitty from dropping too low.

Low BG can occur with infections but that is far rarer than elevated BG. Not sure what antibiotic shot vet gave that is supposed to last 3 days. I wonder if it was Convenia which exerts antibacterial effect for 1 to 2 weeks. Given Sooty's age, they may be reluctant to put him under anaesthetic to do a dental. In those cases, they will sometimes prescribe pulsing antibiotics and offer some pain medication to control any discomfort the dental issues might be causing.

You've done great getting mid cycle tests during the day for the last couple of days and I understand it can be difficult to get mid cycle tests every day if one is working or has other commitments. Try to get mid cycle tests at every opportunity so you can see exactly how much BG is dropping on any given dose.

I'd also encourage you to get some night time data. Our kitties have a habit of going lower at night than they do during the day (another reason to drop the dose a bit now) and with no testing at night you are missing half the picture of what's going on with Sooty. Obviously we all need our sleep, but we recommend getting a test in +2 or +3 post shot and at minimum at least a before bed test every night. That way if Sooty is dropping quickly, you can take action early and keep him from dropping too low. This particularly important when there may be an infection at play that can cause swings in BG.
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You can rely on Linda to give you great advice, Amy, and she's suggested a lower dose tonight which I'm sure most people would agree with.

Ref the food - it's possible that the different foods are giving different bg readings, but there shouldn't be much difference at all between Whiskas and Felix in jelly brands. Felix AGAIL (As Good As It Looks) can elevate bg in some cats, for some reason. What pate do you use? See if there's anything listed in the ingredients that looks like carbs, eg rice, potato, veggies.. any mention of starches?
 
The pate is the Gourmet Pate in salmon, tuna, beef or turkey. To be honest he’s been having it on and off for ages now so I doubt really it’s having much difference in bg.
im just looking for a reason why his bg is dropping and maybe on this occasion there isn’t an obvious one !
I’m happy to go with a 1.25u tonight but will be posting his PMPS level in about an hour for some advice !

x
 
I switched from Caninsulin to ProZinc for my girl. One thing I did with her was give her another snack at +1 to keep her from dropping too fast, I wasn't comfortable with waiting 2 full hours due to how hard and fast Caninsulin hits the body. Are you feeding him 20-30 minutes before shot-time?
 
OK well looking at the Gourmet pate ingredients, it does say "various sugars" and we'd normally suggest avoiding these. If you can, take them out of the diet for a few days and see if you notice any difference in bg. This is the problem with feeding different foods with different ingredients - some things can affect bg and it's hard to say which until they're eliminated.
 
Panic said:
I switched from Caninsulin to ProZinc for my girl. One thing I did with her was give her another snack at +1 to keep her from dropping too fast, I wasn't comfortable with waiting 2 full hours due to how hard and fast Caninsulin hits the body. Are you feeding him 20-30 minutes before shot-time?
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Hi

My routine is to withhold food 2 hours before PMPS, feed (and I make sure he has a good plate full (and sometimes that has to be a mix of Felix and Whiskas). I’m tempted to feed again at the +1 (even if it’s just a snack or a few mouthfuls to slow down the caninsulin)
 
Diana&Tom said:
OK well looking at the Gourmet pate ingredients, it does say "various sugars" and we'd normally suggest avoiding these. If you can, take them out of the diet for a few days and see if you notice any difference in bg. This is the problem with feeding different foods with different ingredients - some things can affect bg and it's hard to say which until they're eliminated.
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ive been using the pate as sometimes it’s the only thing he’ll eat and he licks it from my finger.
felix and Whiskas it is tonight though - I’ve got the good as it looks meaty version and the fish version - he’s sure to like one of them!
 
amy keay said:
ive been using the pate as sometimes it’s the only thing he’ll eat and he licks it from my finger.
felix and Whiskas it is tonight though - I’ve got the good as it looks meaty version and the fish version - he’s sure to like one of them!
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It is tricky I know when you need to get your kitty to eat. The thing is that there may be just one ingredient in one food that could be causing higher bg. The Felix AGAIL can raise bg, as I mentioned, and the various sugars in the pate might do too. Maybe try another brand next time you're shopping, look closely at the labels, and avoid sugars. The Applaws pate is good I think.

https://fetch.co.uk/applaws-natural...VycreCh2IMAoQEAQYAyABEgLspfD_BwE&gclsrc=aw.ds
 
Diana&Tom said:
It is tricky I know when you need to get your kitty to eat. The thing is that there may be just one ingredient in one food that could be causing higher bg. The Felix AGAIL can raise bg, as I mentioned, and the various sugars in the pate might do too. Maybe try another brand next time you're shopping, look closely at the labels, and avoid sugars. The Applaws pate is good I think.

https://fetch.co.uk/applaws-natural...VycreCh2IMAoQEAQYAyABEgLspfD_BwE&gclsrc=aw.ds
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I’ve just looked at all the boxes of food - Felix, Sheba, weebox (premium natural) and they all say contain various sugars.
what should I be looking out for on the labels ? There’s moisture, protein, crude fibres and fats and other constituents
 
amy keay said:
I’ve just looked at all the boxes of food - Felix, Sheba, weebox (premium natural) and they all say contain various sugars.
what should I be looking out for on the labels ? There’s moisture, protein, crude fibres and fats and other constituents
Click to expand...
Well you just want to avoid anything that says sugars or cereals... if those things aren't mentioned in the ingredients list, they won't be included so the food should be ok. Unfortunately manufacturers add these things to make the foods more palatable to cats, and they get used to it and sometimes turn their noses up at other foods that are better for them! Most supermarket foods come into this category. There are various other brands available online that are better quality but more expensive... it's a matter of budget and personal opinion...
 
Diana&Tom said:
Well you just want to avoid anything that says sugars or cereals... if those things aren't mentioned in the ingredients list, they won't be included so the food should be ok. Unfortunately manufacturers add these things to make the foods more palatable to cats, and they get used to it and sometimes turn their noses up at other foods that are better for them! Most supermarket foods come into this category. There are various other brands available online that are better quality but more expensive... it's a matter of budget and personal opinion...
Click to expand...
If there is something better for him out there I’ll have a look in pets at home tomorrow and see what I can find.
I don’t mind paying a bit extra if it’s going to be better for him.
 
He’s hovering in the kitchen for his tea. I’m going to do his PMPS in about 10 mins so if anyone is here please be ready with some advice !

Amy and a hungry Sooty ! Xx
 
amy keay said:
If there is something better for him out there I’ll have a look in pets at home tomorrow and see what I can find.
I don’t mind paying a bit extra if it’s going to be better for him.
Click to expand...

Ok good, that's what many of us here do if/when we can. Personally, I like the Natures Menu range, which comes in a variety of flavours and also a senior version. Country Hunter is part of Natures Menu and a bit pricier but also good.
 
Ok - just done his PMPS - 23.8 !
He hasn’t eaten anything since about 2.30 either

do I still do 1.25u ?
 
He’s reaching his nadir early on in the cycle so I expected it to be high too ! He’s having a good munch now too so will be ready for his shot soon !
 
Just looked up the Webbox Premium Natural - looks like it's in gravy, and ingredients list states cereals and various sugars. Try eliminating that for a few days and monitor what bg is doing.
 
Webbox is gravy and jelly - I bought the jelly one (I did buy the gravy one by mistake but he hasn’t had any). I only tried feeding him this about a week ago (when we started getting strange numbers) so maybe this is the key !
 
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