10/18 Ruby AMPS 391, +6 62, +7 73, +8 73 +10 69 and diarrhea, PMBG 88 Hallelujah!

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by PerfumedCatMom, Oct 18, 2020.

  1. PerfumedCatMom

    PerfumedCatMom Member

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    Oct 8, 2020
    Ruby is doing well today. The Mirtazapine and Cerenia yesterday seem to have stimulated her appetite and she is eating and drinking well. Ketones are still neg/trace. Her poop this afternoon was a little wet but improving over her diarrhea yesterday.

    Should I be concerned about this dramatic drop from this morning to her +6?
     
  2. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    Yes.
    The take action number on an AlphaTrak is 68.
    Do you have any high carb food in the house?
     
  3. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Any symptoms? Ravenous hunger, perhaps?
     
  4. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    @PerfumedCatMom
    Katherine – are you there?

    Can you give Ruby a bit of high carb food or a couple of drops of karo or honey?
    If you have no high carb wet food in the house, put a couple of drops of karo on a piece of kibble.
    Can you get another test in as well? Trying to find out if the 62 is the result of a wonky strip.
     
  5. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    The forum is experiencing a bit of a slowdown at the moment.
    Giving you the information from the Hypo link in case you cannot access. The bold in mine. I've changed the blood glucose numbers to an AlphaTrak.
    GENERAL RULE OF THUMB FOR TREATING HYPOGLYCEMIA

    Hypoglycemia or low blood sugar is a dangerous condition that must be treated immediately. Also known as insulin shock or insulin reaction, hypoglycemia occurs when there is too much insulin in the body potentially leading to neurological damage and/or death.

    Knowing how to respond to a hypoglycemic event whether or not symptoms are present can save the life of your diabetic cat. The following general guidelines are intended for those who home test the blood glucose levels in their cats. These guidelines are not intended to replace the advice given by your Veterinarian. It is very important that you discuss any and all treatment options with your cat’s physician BEFORE an event has occurred.

    SYMPTOMS
    Some cats may have NO symptoms whatsoever, but here are the most common ones:

    MILD HYPOGLYCEMIA
    Sudden ravenous hunger
    Shivering
    Weak or lethargic

    MODERATE HYPOGLYCEMIA
    Disorientation
    Trouble with vision... bumps into furniture
    Poor coordination, such as staggering, walking in circles or acting drunk
    Changes in head or neck movements
    Restlessness
    Urgent meowing
    Behavioral changes, such as aggressiveness

    SEVERE HYPOGLYCEMIA
    Convulsions or seizures
    Unconsciousness


    TREATMENT

    During treatment for hypoglycemia, try to test every 15 - 20 minutes until you see the bgs begin to rise. Then continue to test until you are satisfied that the cat is out of danger.

    VERY LOW NUMBERS – WITHOUT SYMPTOMS
    Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a very low number (under 40 mg/dL or 1.9 – 2.2 mmol/L) administer a teaspoon of corn syrup, liquid glucose, pancake syrup or honey, or INSTA-GLUCOSE and follow with food until the blood glucose numbers rise to acceptable levels. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If using liquid glucose, dilute with water for a thinner consistency.

    LOW NUMBERS – WITHOUT SYMPTOMS
    Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a low number below 68 on an AlphaTrak give food or treats until the blood glucose numbers rise to an acceptable level. If the cat refuses to eat even his/her favorite foods, you can syringe feed or administer a small amount of syrup.


    LOW NUMBERS – MILD SYMPTOMS
    Try feeding first or give a little syrup or honey followed by food until the blood glucose numbers rise to an acceptable level and the symptoms disappear. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If the cat will not eat, syringe feed. If your cat will eat dry food. the high carbs will help to increase his/her bgs quickly, but remember the effects of dry food usually takes longer to clear kitty's system once the crisis has passed. Feeding a high carb canned food is preferable to feeding a high carb dry food because the effects will clear kitty's system faster. You can then follow with his/her favorite canned food. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
    IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

    LOW NUMBERS – MODERATE SYMPTOMS
    Give a tablespoon of syrup, a teaspoon of liquid glucose, a tablespoon of honey or a tablespoon of sugar syrup followed by food and continue doing so until you see the blood glucose numbers rise to an acceptable level and all symptoms disappear. The syrup, honey, or glucose can be rubbed against the inside of the cat’s cheeks or on the gums for quick absorption. You can also mix the syrup with wet food or pour over dry if the cat will eat it. Continue to give syrup and food as needed and observe your cat for signs of recurring hypoglycemia. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
    IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

    LOW NUMBERS – SEVERE SYMPTOMS
    Rub syrup, honey, or glucose on the gums and cheeks if your cat will allow it. Another option for administering syrup, diluted liquid glucose, honey or sugar syrup to a cat who is seizing is to fill a needleless syringe with the mixture and insert via the rectum.
    NEVER TRY TO SQUIRT SYRUP, HONEY, OR GLUCOSE TO A CAT WHO IS SEIZING AS THE CAT COULD CHOKE ON IT! RUSH TO EMERGENCY.

    AGAIN! ANYTIME YOU CAT IS SEIZING OR LIMP, RUB KARO, GLUCOSE OR HONEY ONLY ON GUMS OR ADMINISTER RECTALLY AND GET TO EMERGENCY OR YOUR NEAREST CLINIC IMMEDIATELY!!!

    Remember that syrup or any other sugared syrup/preparation will spike the blood glucose ONLY for a short period of time, so food is really important with mild and moderate symptoms. Dry food (high carbohydrates) will keep the blood glucose numbers elevated longer.

    After a hypoglycemic episode cats may be more sensitive to insulin, so a reduction in dosage is generally required, especially considering too much insulin – whether due to dosage, inadequate food intake, or the cat’s changing insulin requirements – caused the hypoglycemic event in the first place. With moderate to severe episodes, your Vet may have you skip the next injection altogether.
    IT IS VERY IMPORTANT THAT YOU DISCUSS YOUR CAT’S HYPOGLYCEMIC EVENT WITH YOUR VET, SO TOGETHER YOU CAN DECIDE UPON THE NEXT COURSE OF ACTION.

    Always keep in mind that with low blood glucose and no symptoms, the BG you get is not as important as where it is headed. In other words, if you get a BG of 100 mg/dL or 5.6 mmol/L or less and there are still several hours or more before the insulin peaks, your need to watch your cat (and the numbers) carefully and take appropriate steps. With very low numbers and NO SYMPTOMS, a cat can be fine one moment and seizing the next.

    BE PREPARED! KNOW THE SYMPTOMS AND KNOW THE TREATMENT!​
     
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  6. PerfumedCatMom

    PerfumedCatMom Member

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    Hi, sorry for the delay in getting back to you. Sprang into action as soon as I saw your message. I have some of her old Solid Gold Let's Stay Indoors dry food left (35% carbs) and put that in front of her. She might have eaten two or three kibbles. I put some FF Broth on it and then she lapped up a lot of the juice, ate some bits of tuna and a few more kibbles. I rubbed a drop of honey on her chin that she is cleaning off at this moment.

    I will test again in about a half hour.

    THANK YOU for your help, @Red & Rover (GA)!
     
  7. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Phew.

    The dry takes longer to enter the system. The honey does not last long.
    Can you get another test in now to see which way she is headed?
     
  8. PerfumedCatMom

    PerfumedCatMom Member

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  9. PerfumedCatMom

    PerfumedCatMom Member

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    She knows something is up so she is hiding under the couch now but I will try to coax her out and test again. Will post the results.
     
  10. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Good. No symptoms does not mean complacency, however. Cats can go from having no symptoms to seizures in seconds.

    And congratulations. Ruby has earned a reduction by going below 90 (as per SLGS). Your new dose is 1.75 units but I'm wondering if it should be more. I'll let other, more experienced, dosing people weigh in on that.
     
  11. PerfumedCatMom

    PerfumedCatMom Member

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    Whew hew! I found some Hill's MD, which is not HC but MC and she is chowing down on that right now. Hopefully that will have some good effect on her BG.
     
  12. Panic

    Panic Well-Known Member

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    Any new test?
     
  13. PerfumedCatMom

    PerfumedCatMom Member

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    Sorry will do it in a few minutes. Ruby’s civvie sister just left some diarrhea in the box that smelled horrible so I have to clean it up. It never ends!
     
  14. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Another test is very important. Need to figure out if Ruby is heading up or down. As soon as you can please. Sorry about the odiferous litter box.

    Katherine – Elizabeth will stay with you for the next short while. I have to run out quickly.
     
  15. Panic

    Panic Well-Known Member

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    Test every 15-20 minutes until you get her over 68. If she is still not over 68 you need to give her more honey/syrup with the MC since you don't have HC. Be sure to put up a few cans asap for next time.
     
  16. PerfumedCatMom

    PerfumedCatMom Member

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    It’s 73 now!
     
  17. Panic

    Panic Well-Known Member

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    Okay, more MC food and check in 20 min please. We need to make sure she stays up without the honey.
     
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  18. PerfumedCatMom

    PerfumedCatMom Member

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    Found some canned Science Diet Adult Entree in the closet that the vet gave me and only realized now that it's HC. So I have some on hand now. Tried to make her eat some of it but she had a 1/4 can of the m/d so isn't interested.

    Will try to test her again in a few minutes.
     
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  19. PerfumedCatMom

    PerfumedCatMom Member

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    Holding steady at 73.
     
  20. Panic

    Panic Well-Known Member

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    Glad she's not dropping but still pretty low. I am not familiar with Alphatrak numbers past 68 being the take-action number but I expect she'll be better off being over 80-90. Can you keep feeding/checking every 20-30 min until she gets that high? Then hold off food and check in 30 to see if she's holding her own. Sorry I can't be of more help.
     
  21. tiffmaxee

    tiffmaxee Well-Known Member

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    It can take 20-30 minutes for the food to effect the bg. Hc or mc is fine, whatever she will eat.
     
  22. PerfumedCatMom

    PerfumedCatMom Member

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    OMG, you've been such great help! I wish I could get her to eat but she's turning her nose up at everything since 3 PM (about 1 ½ hours ago).
     
  23. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Hi Katherine. I'm back.

    We would really like to see Ruby start to rise.
    Any more of that tuna left? Perhaps with a drop of honey on top?
    Or a bit of the FF broth with honey added?

    It is important to not fill her up with food during a low numbers situation. It is easier to get a hungry cat to eat.
     
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  24. PerfumedCatMom

    PerfumedCatMom Member

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    Doing some broth with honey...turned her whole body away from it. Should I rub some honey on her chin again?
     
  25. tiffmaxee

    tiffmaxee Well-Known Member

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    She sounds nauseous. When is her next dose of cerenia?
     
  26. tiffmaxee

    tiffmaxee Well-Known Member

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    What’s her favorite thing to eat?
     
  27. PerfumedCatMom

    PerfumedCatMom Member

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    I gave Cerenia to her around 2:30 after I tested and before she ate.
     
  28. PerfumedCatMom

    PerfumedCatMom Member

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    Right now her favorite thing is the broth but she won't even look at it this very moment.
     
  29. tiffmaxee

    tiffmaxee Well-Known Member

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    83 isn’t horrible. When was that test?
     
  30. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    See if she will eat out of your raised hand. Animals don't like lowering their heads lower than their bodies if they are nauseous.
     
  31. PerfumedCatMom

    PerfumedCatMom Member

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    It was 73, not 83, at +8 (less than an hour ago)
     
  32. PerfumedCatMom

    PerfumedCatMom Member

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    I think Ruby is very stressed by my very bad testing. Her poor ears are covered in scabs. It might account for why she's not eating anymore. I am going to check back in around +11.5 and see if I should give her her dose and how much.
     
  33. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    Is it possible to get just one more test? It is important to make sure that she is on her way up and not heading back down. As you saw on the 12th, her +10 test of 329 was lower than her +8 test of 345. Sometimes Lantus has a longer duration.

    Neosporin with pain relief ointment (not the cream) will help with her ears.
     
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  34. tiffmaxee

    tiffmaxee Well-Known Member

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    If you see this I would syringe a little. I read it wrong.
     
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  35. PerfumedCatMom

    PerfumedCatMom Member

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    Have tried everything to get her to eat more. Tried to syringe but she ran away. Will try to coax her into testing soon.
     
  36. cabreu

    cabreu Member

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    Have you tried applying some vaseline/other ointment after testing?
     
  37. PerfumedCatMom

    PerfumedCatMom Member

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    She's at 69 now. @Red & Rover (GA) @Panic @tiffmaxee Am going to throw out all of her old food in the bowl and replenish with new and see if she will eat that now. She is very finicky that way.
     
  38. PerfumedCatMom

    PerfumedCatMom Member

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    Now she has had a bout of diarrhea. I may have mistaken the earlier bout of diarrhea for her sister's. Help?
     
  39. tiffmaxee

    tiffmaxee Well-Known Member

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    Did you check for ketones? We’re you able to get a bg reading? That needs to be done.
     
  40. PerfumedCatMom

    PerfumedCatMom Member

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    Tested her about 40 minutes ago and it's 69. I can't check for ketones because no pee since this morning but it looked fine, neg/trace.
     
  41. Sue and Luci

    Sue and Luci Well-Known Member

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    She's had a lot of different foods today - may have caused a little upset tummy there.

    Just keep an eye on her this evening. Congratulations on the reduction - although the way she earned it is quite the ordeal isn't it?

    Will she eat Fancy Feast gravy style foods? Many of them are medium and high carb. I've got quite a variety on had for Luci's dives.

    Didn't know if you had the link for the food chart or not - so here it is just in case :)

    https://catinfo.org/chart/index.php
     
  42. PerfumedCatMom

    PerfumedCatMom Member

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    If she doesn't go back up past 100 by her PM shot, should I not give her insulin?
     
  43. tiffmaxee

    tiffmaxee Well-Known Member

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    @Sue and Luci She’s using an AT. I don’t know if she will be able to shoot tonight unless there’s a big jump in bg and she will eat
     
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  44. Sue and Luci

    Sue and Luci Well-Known Member

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    How many hours until your next shot decision?
     
  45. tiffmaxee

    tiffmaxee Well-Known Member

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    I’m not sure even 150 would be a safe number to shoot the full 1.75.
     
  46. Sue and Luci

    Sue and Luci Well-Known Member

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    I'm expecting a bounce...that's why I'm wondering how many tests can be obtained between now and PMPS - then make the decision based on that. Katherine and Ruby are new to this and newbies really shouldn't shoot below 200 ....need more time to gather data and find out how their cats are responding.

    Ruby is also new to that low number she saw today...I'm just wondering how long before her liver starts to unload...and she's going to bounce to the moon...

    Since no one puts their location in the avatar/info I can't tell where she's at...US vs ? I just don't know what we're dealing with here based on the last BG...:rolleyes:
     
  47. PerfumedCatMom

    PerfumedCatMom Member

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    One hour.
     
  48. Sue and Luci

    Sue and Luci Well-Known Member

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    So what was the last number you got? Since that last 73 on the SS?
     
  49. PerfumedCatMom

    PerfumedCatMom Member

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    Sorry, it was 69. Just filled it in.
     
  50. tiffmaxee

    tiffmaxee Well-Known Member

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    Yes and she was at 136 yesterday at amps and she skipped. Now with diarrhea and no appetite I am not sure if skipping is necessay or if sky high a 1/4 dose.
     
  51. tiffmaxee

    tiffmaxee Well-Known Member

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    She said 69 about 50-60 minutes ago I’m guessing.
     
  52. Sue and Luci

    Sue and Luci Well-Known Member

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    So her test at 6 p.m. is 69 - so she's still sliding down.

    Then the PMPS is at 7 p.m. ? or 8 p.m. (you're on eastern standard daylight savings time, right, same as I am)...It's 7 p.m. here in Michigan now.
     
  53. Sue and Luci

    Sue and Luci Well-Known Member

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    Sorry, I was looking at the SS...since I haven't been on much today - my boss had the nerve to call early this afternoon and had me working!

    So anyway, the issue is whether or not the PMPS will be well above that AND if Ruby is eating or not. Based on what's happening then it may not be a night for shooting....there's always tomorrow morning :)
     
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  54. tiffmaxee

    tiffmaxee Well-Known Member

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    The nerve of your boss. I agree. Skip.
     
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  55. PerfumedCatMom

    PerfumedCatMom Member

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    @Sue and Luci @tiffmaxee So if she stays below 200 at her PMPS, I will not give her anything. Correct? And test her every hour or two until I collapse from exhaustion?
     
  56. Sue and Luci

    Sue and Luci Well-Known Member

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    I would not advise shooting under 200 tonight - based on her diarrhea, not eating and already low numbers today.

    However you may get a pokie break tonight because she's going to bounce from that low number she got today - bounces typically appear within hours of hitting a low number - it's a natural response to a perceived dangerous situation - the liver releases all its stored glycogen in response and so the resulting BG numbers are going to soar.

    Lantus will eventually help that to level off...but it takes time...so you may not need to wait until you collapse from exhaustion. You've already had a big day ... but tomorrow will be a new day and you guys can start over in the morning.

    It's always hard to predict how the BG numbers will look in the next hour or two - that's why it is strongly recommended to get a PRE-SHOT test. Never ever would I shoot without getting a pre-shot test. Cats have been known to drop over 100 points in an hour - Luci does it routinely. She can drop from the 200's to below 100 in an hour...take a look at her SS...she's a championship diver...and really used to give me a run for my money...that's why I have a pantry-load of gravy style foods - with the carb count written on the bottom of every can - some are 13%, all the way up to 21 or 23% - being prepared for a dive is the easiest way to handle them.

    So let's just see where she's at in an hour...but I suspect if she's dropping now, she most likely isn't going to hit that big load of sugar in an hour...but it's coming...maybe just in a little while...or not. They love to keep us guessing about those things :)
     
  57. tiffmaxee

    tiffmaxee Well-Known Member

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    If you skip I suspect her bg will rise and not come down again so you won’t be up all night. With less than an hour to go that’s is what I suspect will happen. So don’t give any. Keep offering her food.
     
  58. PerfumedCatMom

    PerfumedCatMom Member

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    She's lying on the bed now with a plate of her favorite MC kibble and a plate of FF broth. I'm hoping she will go for one. Should I still do a PMPS test, if as you say it probably won't tell us much?
     
  59. thebigfuzz

    thebigfuzz Well-Known Member

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    Mar 9, 2012
    Yes, a PMBG would still be a good idea. Even if you will skip. The depot may still be in play for a while longer.
     
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  60. PerfumedCatMom

    PerfumedCatMom Member

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    Will do!
     
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  61. PerfumedCatMom

    PerfumedCatMom Member

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    PMPS is 88. Now I can sleep tonight!
     
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  62. Blaze and Paola

    Blaze and Paola Member

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    How's Ruby?
     
  63. PerfumedCatMom

    PerfumedCatMom Member

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    She is lying in bed and not doing much after her bout of diarrhea. Has not eaten for 5 hours. Her BG is going up though, but not giving her a shot tonight. Will wait to see what tomorrow AMPS brings and whether she is eating. If not, another trip to the vet.
     
  64. Blaze and Paola

    Blaze and Paola Member

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    Yes, best to hold off on the insulin tonight. When you add the diarrhea to the mix, things are even harder on our kitties. Hopefully she will feel hungry in the morning so you will feel more at ease shooting. Fingers crossed, I also hope the diarrhea goes away. If it lasts for more than 2/3 days though, talk to your vet and get some antibiotics. I had to do that with my Blaze...and the antibiotics helped him big time.
     
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  65. PerfumedCatMom

    PerfumedCatMom Member

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    I mistakenly bought the cream, so I put Vaseline on her ears before I prick and then the Neosporin cream after. I think I might be getting better at it, but she still hates it and squirms a lot.
     
  66. thebigfuzz

    thebigfuzz Well-Known Member

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    Hi! Since you didn’t shoot tonight, you would want to change your title to PMBG rather than PMPS when you have a moment. Others scanning the thread titles may worry if they think insulin was given after your exciting day :)

    PMPS (pm preshot) indicates a shot given
    PMBG (pm blood glucose) no insulin

    I hope the diarrhea improves and appetite returns :bighug:
     
  67. PerfumedCatMom

    PerfumedCatMom Member

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    Oh thank you so much for letting me know! I really am such a newbie. o_O

    Thanks everyone again for holding my hand through another roller coaster day! :bighug:
     
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  68. Blaze and Paola

    Blaze and Paola Member

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    Blaze used to squirm too at first, I was not good at it either...But he eventually got used to it. I tried to make it kind of like a ritual...I repeated the same actions, sounds and words and after a while he knew and just waited for me to finish. For me the game changer was buying a head light because I wanted to see better the exact spot to prick on. Little did I know, the turning on and clicking sound of the light, was what trained him to understand it was BG testing time and he would just sit and wait.
     
  69. thebigfuzz

    thebigfuzz Well-Known Member

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    We were all new once too :bighug:

    How did the race go by the way?
     
  70. Blaze and Paola

    Blaze and Paola Member

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    This board is absolutely amazing, they held my hand too throughout our own diabetes struggles. You couldn't be in better hands with the loving, experienced and knowledgeable people here.
     
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  71. PerfumedCatMom

    PerfumedCatMom Member

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    Tomorrow will be a week since I started the BG testing and I know it might take a few more weeks before she is willing to forgive me for torturing her. :)
     
  72. PerfumedCatMom

    PerfumedCatMom Member

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    It went well! Gorgeous day in NYC, 49 degrees and dry at race time. I didn't break any personal records but I did do 5k in under 30 minutes, which is great considering I didn't really train for a short and fast race. I've been training for a half marathon, so that's been about emphasizing endurance over speed. Considering I only started running two years ago and I'm OLD, I think I'm doing pretty well. Thank you for asking about it!
     
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  73. Blaze and Paola

    Blaze and Paola Member

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    I am 100% convinced that our cats know we are helping them, even though we think we are torturing them. I think (and that is my own "newbie" theory) that they already feel a difference in how they feel as soon as you start giving them that insulin. Cats are intelligent. Ruby is probably starting to realize the extra "attention" she is getting helps her feel better.
     
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  74. Blaze and Paola

    Blaze and Paola Member

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    I run too!
     
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  75. PerfumedCatMom

    PerfumedCatMom Member

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    Oct 8, 2020
    I'm hoping she gets it. She is my heart. :bighug:

    When did you start running? It's become a bit of an obsession for me.
     
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  76. cabreu

    cabreu Member

    Joined:
    Jul 30, 2020
    I bet she will get used to it. I think what people have said about the lack of nerve endings in the ear edge must be true. My cat doesn't mind it at all anymore, 2 months after starting regular testing. She actually minds the shot more, since she gets a large dose and the Lantus is acidic and apparently stings at high doses.
     
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  77. PerfumedCatMom

    PerfumedCatMom Member

    Joined:
    Oct 8, 2020
    Awww, poor Willow! I can't imagine. I hate getting shots myself!
     
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  78. Blaze and Paola

    Blaze and Paola Member

    Joined:
    Aug 29, 2020
    I started about 6 years ago and I am obsessed too...I bought a treadmill in June. Gyms here are now shut down again so i can continue running at home.

    Yes my cats are my babies, my heart, my everything too...:bighug::bighug:
     
  79. cabreu

    cabreu Member

    Joined:
    Jul 30, 2020
    Diabetic cats are troopers!
     
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