reductions fail at first, but then hypos sneak up on me??

Discussion in 'Feline Health - (Welcome & Main Forum)' started by apollonia-artemisia, Nov 24, 2022.

  1. apollonia-artemisia

    apollonia-artemisia Member

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    hey everyone, I've been having some restless nights because I don't fully understand what is happening with cadmiums blood sugar. can someone please look at my spreadsheet and give me their impressions? my vet is wanting him to not drop under 75, but to keep him below 200 as much as possible. his nadirs occur at +6. i have been consulting the dosing guide, but need a second pair of eyes.

    I've been very stressed trying to figure out if hes not getting a high enough dose, having a bounce from lows i didn't catch, or to see if he needs to be taken off of insulin from being too low from too long. i haven't been able to sleep very well for the past few nights, and i keep feeling like im doing something wrong and constantly close to crying. :(
    thanks in advance for any help

    ETA: spoke with vet who looked over the spreadsheet and says the 0.25U dose doesn't look like it's enough for him, and wants him to go back up to 0.5U. i agree with this plan UNLESS his values level out and behave themselves. he would very gradually taper his dose with thorough monitoring, after being on this current dose of 0.25 for at least a few days (with reevaluation to determine the trend)
     
    Last edited: Nov 25, 2022
    Reason for edit: updates and clarification, sorry!!
  2. Lando demando

    Lando demando Well-Known Member

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    Hi there, im sure a more experienced member will be able to give you some useful advice onve the holiday cools. I am not a prozinc user so i am not sure i should weigh in. I assuming someone will address the rapidity in dosage change and the dosage itself. Good luck. I wanted to post to let you know that someone is here for you. Also...i spent months crying and worrying. It gets better, i know it feels dire now, but take a breath, it will even out:bighug:
     
  3. apollonia-artemisia

    apollonia-artemisia Member

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    the rapid dosage changes is because of him having low blood sugars, if i didn't address the episodes when i did they would have gone well below 75 as it was nowhere near his nadir :( so he had to get food and extra thorough monitoring, and next dose lowered was my understanding? i think?? essentially I've been having to substitute the "below 50" in the instructions for "below 75" as hes not even diagnosed for a full month yet.
    thank you for your response, i appreciate it a lot- and this whole "insulin is suddenly way more effective" thing is very stressful!!
     
  4. Lando demando

    Lando demando Well-Known Member

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    Yes, you are correct about reductions. I looked at cadmiums sheet on my tiny phone, so maybe i didnt see it all! ;). There are amazing members on this forum that will hep you after the holiday ( i promise). My lando is over a year diabetic and this forum has helped make his life stable and happy. I know it all seems overwhelming now, but it will get better little by little. Sending you tons of compassion
     
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  5. apollonia-artemisia

    apollonia-artemisia Member

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    thank you so much ;o; its just been a rough go especially this past week. at one point yesterday his glucose fell to 78 only 2 hours after his night dose!! then even with extra food it stayed right around there for 3 hours in a row, it was so scary! has Lando ever done anything like that to you?
     
  6. Lando demando

    Lando demando Well-Known Member

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    Yes, i remember in the early days staying up 5 hrs past my bedtime to monitor his low BG. Every cat is different, but most of us have felt scared, frustrated, guilty, anxious etc... youre not alone. I promise you will get over this learning curve! But you also may still may have a tough month or two before it gets better. Lean on this forum and be gentle w yourself.
     
  7. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    I can try tagging Suzanne for you
    @Suzanne & Darcy
     
    Last edited: Nov 24, 2022
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  8. apollonia-artemisia

    apollonia-artemisia Member

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    thank you, im just at a loss of what dose i should be giving him next with these higher values considering he will have falls to low really easily lately :(
     
  9. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Cadmium is bouncing today. As you said, he got low (for him) last night, and his body is reacting with the bounce. And no, it's not a Symogyi effect as per your spreadsheet. The Symogyi study was done decades ago on a very small sample size, on humans, and rapid acting insulin. Recent studies on cats, and longer lasting insulins, have shown that Symogyi is very rare. What you are seeing is a plain old bounce. He's just not used to that lovely stretch of safe greens he saw last night.

    For the dose, stay the course with 0.25 units. When the bounce is over, you don't want him dropping low on 0.5 units again.
     
  10. apollonia-artemisia

    apollonia-artemisia Member

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    Okay, sounds good!! Part of my worry was that the greens were actually too close to the restrictions his vet put in place for my comfort. Especially so considering after some experimenting at the vets office, the meter hes on right now is very close to the AlphaTrak 2.

    I wasn't sure if cats had the Somogyi effect but when I consulted his vet about previous bounces and dose reductions she said that it was likely the effect to blame- so that's why it was added to his sheet. All in all she said "body's natural defense against low blood sugar" and that its safer to be too high than too low, which to me also sounds like a bounce, haha.

    I was just scared because he got to 78 only two hours after his rather small dose, and only stayed in the green because he had food. If he didn't, his sugar would have sank like a stone. This has been happening a lot lately with his insulin even at lower and lower doses, so I wonder if he will be able to start his trial soon? Its all up to the little man's pancreas I suppose!
     
  11. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Unfortunately, far too many vets have not read the latest research about Symogyi, so still throw that word around. To be fair, as a vet, it is hard for them to keep up on all the latest papers on all those animals and conditions they have.

    Are you using the AccuCheck or the Relion primarily now?

    In order for a cat to become regulated (something that has to happen well before a trial), they have to start getting used to longer and longer stretches of normal blood sugar values. Feeding him some low carb food when he first goes below 100 can often help him "surf" or hang our in those normal green numbers, that are also pancreas healing numbers. So you did exactly the right thing last night.
     
  12. apollonia-artemisia

    apollonia-artemisia Member

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    Primarily using the AccuChek Guide Me instead of the ReliOn. I dont know if its my meter or the strips getting exposed to the cold, but the ReliOn started having readings 60 points below the AccuChek when it used to be toe to toe with it. I'll update that in my signature and spreadsheet.

    Makes sense! Thank you for explaining that, as I mentioned earlier it hasnt even been a full month since diagnosis for him, and approximately 2 months now since full blown onset of his symptoms. Can you think of anything else I should keep an eye out for while his dose has been reduced? Vague and broad question I know, its just cat diabetes behaves quite a bit differently than I expected!
     
  13. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    You are doing a great job testing. It does look like you'll be able to get a bit more sleep tonight. That's the one benefit of those bounces!

    Are you testing him regularly for ketones? That's the main worry in higher numbers. Here's a post that may help: Tips to catch and test a urine sample
     
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  14. apollonia-artemisia

    apollonia-artemisia Member

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    I havent been able to test for ketones just yet, as I'm needing to get ahold on some of the test strips. I have been paying close attention to his water intake and urine output though, which I know is not the same thing but it'll at least help with telling me whether I need to get them right this second just put it on the credit card and worry later or if it can wait until the next time I get benefits (first of the month). But I do plan on getting them soon so I can test! I also have been keeping track of how his breath smells lol, I don't know if thats much of a thing for cats but I do know that in diabetic humans if your breath smells fruity or like acetone its an emergency!
     
  15. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Some people say they can smell ketones in their cats, other not. Maybe it depends on your nose? I would worry if he goes off his food at all, and not so much his fluid throughput.
     
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  16. apollonia-artemisia

    apollonia-artemisia Member

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    Interesting! He has been having good appetite, so is that the thing to monitor regarding ketones?
     
  17. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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  18. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    I would take Wendy's comments about Somogyi a bit further. I did go back and look at the research. The consensus is that even in humans, the original research that was done in 1938 could not be replicated. The study that was actually done with cats that were prescribed Lantus could not document anything close to chronic Somogyi rebound. The entire concept seems to have become an urban myth.

    My reaction to Cadmium's spreadsheet was also that you're seeing a bounce.

    You may want to evaluate whether the SLGS vs Modified Prozinc Method may be a better option for your cat. The biggest difference is in whether you adjust the pre-shot dose. While seeing numbers in the 70s may be a bit of a nail biter early on, those are really good numbers! Ultimately, you want to be seeing your kitty spending as much time as possible in normal range numbers (50 - 120). The more accustomed Cadmium is to spending time in that range, the less your cat will bounce and the happier his pancreas will be.
     
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  19. apollonia-artemisia

    apollonia-artemisia Member

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    Is it okay if I use a combination of methods depending on his needs? Meaning if his levels arent balanced out by 3 days-6 cycles, modify the dose- if they are balanced keep him on it for a full week and reevaluate at that time? Thats sort have been my approach for tweaks unless he hits a point where hes going to plummet before his nadir, then the next dose gets reduced. The only other time he would have his dose increased is if an attempted reduction has obviously failed.

    Right now hes still having spikes up to 500, so I am trying to stay at this dose for a bit and keep him active to try and burn off that extra fuel. The main question I'm combating is if and when to increase/decrease. This is all really complicated stuff :confused:
     
    Last edited: Nov 25, 2022
    Reason for edit: forgot some words
  20. apollonia-artemisia

    apollonia-artemisia Member

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  21. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    To be honest, you and Cadmium are still so new to diabetes management, I truly think you'd be better off sticking with one method. It will give you the time to understand how your cat is responding to insulin and provide you with a set of guidelines for dosing. If you're using a combination of SLGS and TR, it will make it next to impossible for us to help you since we won't be familiar with what your decision rules are for dosing.

    Looking at.your spreadsheet, I would also make a suggestion. Rather than not shooting if numbers are below 200, you may want to consider posting and asking for help. With SLGS, there are options other than skipping whereas with TR, we routinely shoot lower.
     
  22. apollonia-artemisia

    apollonia-artemisia Member

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    Insulin seems to be really effective for him, I'll need to weigh the pros and cons of each method. I'm also waiting on a call back from his vet to discuss a plan going forward.

    Unfortunately I have been trying to post/reply/tag people for advice on what to do with his numbers, and have routinely not gotten a response for hours at a time :( So part of the reason why I've been having a hard time deciding what to do is because I'm needing to make decisions on the fly. What I am especially needing to know right now is: at what point will I need to consider a reduction as "failed"? Meaning, at what point does it stop being a bounce, to be failed reduction.

    Sorry, I'm just feeling pretty discouraged lately. I just wish I had the answers to a lot of things, of course all happening at once.
     
    Last edited: Nov 25, 2022
  23. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Try to not feel discouraged. You have been working at Cadmium's diabetes for less than a month. This is not a short term project!

    Holidays are a particularly tough time as not that may people are around. Also, there are fewer experienced people who are Prozinc users. One additional way to reach an experienced person is to send then a PM and ask then to reply to your thread (and give them the link). We can't reply to a private message regarding dosing issues but the PMs trigger an email -- or at least mine are set up to do that. We only get tags if logged in to the board.

    It can also help to keep in mind that a bounce can take 3 days to clear. In addition, a drop from 501 to 265 has triggered another bounce. Fundamentally, bounces are more frustrating to us than to our kitties. If nothing else, managing a cat's FD teaches us patience.
     
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  24. apollonia-artemisia

    apollonia-artemisia Member

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    I know its not a short term project, I'm just scared that I'm ruining his chances of potential remission by not knowing what to do. I mean, I had an easier time treating his spinal infection that was a couple years ago! And it's hard seeing him slip back into grouchy old man mode, as that means he's not feeling well... :'(

    I consulted with his vet over the phone and shared with her the values he was getting. While she was looking over his spreadsheet, she was concerned about the fact that he's been getting consistently high values that arent changing that much- and wants him to go back up to 0.5U cautiously. She said that was the last time he was getting values that she likes, but to make sure to offer extra food and to check on him every now and then. Considering hes not having much of a curve to his glucose anymore and its staying stuck at mid 400s, I think it's a good judgement call... Based on how he's rather sensitive to insulin though, I'm going to do that gradually. Do you have any thoughts on this?
     
  25. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    I might wait until at least AMPS tomorrow before changing the dose. You don't want to increase at the same time a bounce is breaking.

    When or if you do increase, you would want to increase to 0.5u.
     
  26. apollonia-artemisia

    apollonia-artemisia Member

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    Yeah.... I don't feel comfortable increasing it that much overnight, now or ever! Not unless I can stay up all night. And thats the plan, he would be returning to 0.5 units.
     
  27. FrostD

    FrostD Well-Known Member

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    Sorry I was away - home from hospital now, sort of. Whole family has RSV so baby and I had to get some temporary housing of sorts...children's hospitals here are 95% full so not risking anything

    My suggestion would be to follow SLGS with the modified reduction point of 75 per your vet. As bouncy as he is and as low as he can go, I think he would benefit from holding doses a little longer (and also gives you a little more time to see how a dose is truly doing).

    If he were just high and flat all the time perhaps a different story, but you're pretty much at the right dose at the moment.

    Agree with Sienne and shooting lower - you did the right thing when you shot the 158 by getting the extra tests in. Over time you'll learn to shoot lower, and what dose to shoot.

    Feel free to tag Suzanne and I in your posts; I've been trying to pop in once a day still as best I can.

    Oh also - if.you tag someone, then go back and edit the post, that usually breaks the tag for whatever reason and we don't get the alerts
     
  28. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    @FrostD Hi Melissa, so you had your baby, I forgot a boy or girl, what name did you pick. I hope your felling good, sorry about your family had RSV . I hope they feel better soon
    @apollonia-artemisia
    didnt mean to Bogart your thread :bighug::cat:
     
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  29. apollonia-artemisia

    apollonia-artemisia Member

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    How strange, I didn't know it would break the tag. Sorry about that.

    I think he is needing to have his dose increased though (but tomorrow morning) because he's acting... off. Not as sickly as he would be completely off of insulin, but hes slower at eating than usual? He's still eating, just slow about it. I don't think I'll jump quite to 0.5 unit, maybe a 0.25F to see how he does with check-ins. I genuinely feel he's failed this reduction after seeing his condition through these past few cycles. If he drops again tonight then that changes things, of course.

    But yeah.... I'll give SLGS a shot (pun not intended) once he's in better condition!
     
  30. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Hi if you are going to give SLGS you need to add that to your signature and spreadsheet please
    @apollonia-artemisia
     
  31. apollonia-artemisia

    apollonia-artemisia Member

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    I know, I will. Thanks for the reminder!
     
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  32. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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  33. apollonia-artemisia

    apollonia-artemisia Member

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    I've been reading and rereading this practically daily, maybe I will wait a bit longer on the 0.25 dose considering he did go below 90 on the 0.5 dose..... am I understanding that correctly?
     
  34. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Remember that it can take up to 6 cycles for a bounce to resolve and you are not at 6 cycles yet. I know it is hard and frustrating to see your kitty in higher numbers :bighug:but patience is needed with bouncing. I know because Sheba was a very bouncy cat and I used to get anxious about it until I understood bounces. Once the bounces ends the BGs numbers should come back down.
     
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  35. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    @apollonia-artemisia sent me a PM:
    Just wanted to ask for clarification about the start low go slow method, considering he did go below 90 the night he got his dose after 158, I did the right thing by reducing his dose another 0.25.... right? Meaning the correct path for that method, of course. I'm just trying to understand what it means, and somehow my brain keeps getting tripped up over how things are worded- probably from being tired honestly...

    But also, what would happen if he hits below 90 again while on 0.25? Does that mean I would not give injections and monitor his glucose to see if its managed? Or something else?


    Yes, you did the right thing reducing the dose when he dropped below 90 with SLGS.

    This is what @FrostD said about reductions in post 27 above:
    My suggestion would be to follow SLGS with the modified reduction point of 75 per your vet. As bouncy as he is and as low as he can go, I think he would benefit from holding doses a little longer (and also gives you a little more time to see how a dose is truly doing).

    If he were just high and flat all the time perhaps a different story, but you're pretty much at the right dose at the moment.


    I can see you have put this into your signature….which is great so we can see it. So in future you don’t reduce the dose when he drops under 90 but wait until he drops under 75.
    If he drops under 75, I would post and ask for advice by tagging either Suzanne and Darcey or FrostD. The next dose after 0.25 is 0.1U.
    I would recommend you post each day so we can see how you are going and we can help you.

    upload_2022-11-26_17-57-15.jpeg
     
    Last edited: Nov 26, 2022
    Reason for edit: Fixed autocorrect
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  36. apollonia-artemisia

    apollonia-artemisia Member

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    thank you for your reply explaining!! sorry im struggling with reading comprehension overall it seems, really need sleep :facepalm:

    would i start a new thread for each day? or should I just respond to this one until it hits 50 replies?
     
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  37. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Don’t apologise for wanting to know information. It’s important you understand what you are doing and we love people who are proactive and want to learn! :)

    On the main health page you don’t need to start a new thread each day. But when you start a new thread you link your last thread to it so we can go back and look at it if we need to.
    I think I would start a new thread to tomorrow as this one is starting to get longer and it’s easier for the people helping if we don’t have to go through long threads when answering.
     
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  38. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    I want to make an observation. Hypoglycemia means that your cat has symptoms of hypoglycemia. The symptoms to be concerned about include but are not limited to:
    • staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
    • ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
    • disorientation (yowling, walking in circles, etc.)
    • twitching
    • stupor
    • convulsions or seizures
    • coma
    I'm assuming that your cat was not symptomatic. From your spreadsheet, the lowest the numbers have dropped appears to be 78. That's a normal range number. There is a difference between low(er) numbers and a symptomatic hypoglycemic event. My kitty had a few times when her numbers were in the 30s. She looked a bit glassy eyed but I caught the drop and bumped up her numbers without any of the symptoms noted above.
     
  39. apollonia-artemisia

    apollonia-artemisia Member

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    As I stated, his nadir is at +6. That value occured at +2. The only reason he didn't become symptomatic is because I took action and gave extra food, as his blood sugar was sinking like a stone. He had 1/2 can at +2, and another 1/2 can at +4 as his values were coasting around that range. If he was alone for another four hours however, it would have not been a good time. Plus, I was instructed by his vet to not let him drop below 75. I know how hypoglycemia feels, as I have non-diabetic hypoglycemia. It sucks! So I am extra cautious and try to head off any episodes that are about to happen, and that's part of the reason why its been hard to sleep lately. His insulin is becoming more and more effective out of nowhere, and that's really scary sometimes.
     
  40. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Let me offer a suggestion. Take a look at Gabby's spreadsheet. If Gabby's numbers were dropping, I was testing more often than every hour. I could gently (or not so gently) bump up her numbers with higher carb food (which in her case was corn syrup since she was intolerant of the gluten in high carb food). I'm offering this as an option because it looks like you did a great job of keeping Cadmium surfing in green numbers during the PM cycle on 11/23 and then loaded her with carbs and the numbers spiked into the 300s. If you did that so you could get some sleep, that's fine. Ideally, propping the numbers up to keep your cat in a flatter cycle that reflects those really good numbers is what you're wanting. The longer your cat spends in normal range numbers, the more her body is going to get used to being back in that normal range.

    Also, Cadmium's nadir is not always at +6. It may be at +6 some cycles but it's not always there. Nadirs are fickle -- they can and do move around. On 11/20, nadir was at +4 and it was at +2 on 11/23. Yesterday, the cycle was flat and was dropping late in the cycle and your low point was at PMPS. Generally, you can see a trend toward where the nadir may typically be the minute you think you know where it is, your cat will surprise you.
     
  41. apollonia-artemisia

    apollonia-artemisia Member

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    I did not give him carbs, the food was low carb :(
    He spiked while I fell asleep unintentionally, as this was around 3:30am.
    I also do know that his nadir is not always at +6, thats merely the average I use as a frame of reference- but his glucose did practically halve itself by falling 80 points in two hours. This is what I meant by hypos sneaking up on me, as when I fell asleep I believe he suddenly hit that low point and his body spiked in reaction. The one hour I wasn't looking, something happened.

    I will look at Gabby's sheet, I'm just trying to figure out how I would take note of extra tests in the SS when its more often than hourly. I suppose in the notes?
     
  42. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    You can indicate additional tests in the notes but it's better to "stack" the numbers in the cell on your spreadsheet. You'll see what I did on Gabby's SS. You will have to manually color the cell, though. I like stacking the numbers since not everyone will look at the comments section of your SS. Another alternative is to add a comment to the cell. If you've never done that, there's a comment feature in the Insert tab.
     
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  43. FrostD

    FrostD Well-Known Member

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    As Bron said, do wait for the bounce to clear (6 cycles/3days) before making any dose decisions. We have all seen our fair share of cats start at 300+ only to break the bounce and end up green in that same cycle - adding a dose change on top of that can be trouble.
     
  44. apollonia-artemisia

    apollonia-artemisia Member

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    Good call, as I believe his bounce might be settling down. His AMPS today was 288!
    I just wish his pancreas didn't decide to make its hobby to stress me out, lol.
     
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  45. FrostD

    FrostD Well-Known Member

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    A girl, Evelyn :) so far we're good, I tested negative for RSV but positive for antibodies, so hopefully even if she does get it that's enough protection to keep her out of hospital. Very scary in the newborns.
     
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  46. FrostD

    FrostD Well-Known Member

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    That would make a good t shirt lol
     
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  47. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Hi Melissa I'm so glad everything is good so far, such a pretty name.
    Sending prayers everything stays good :bighug::bighug::bighug::bighug:
    @FrostD
     
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