Treating lows...how low is low enough?

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Linda and Tasha

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My experience with diabetes is with people and with a person anything in the 60s should be treated with a quick sugar followed by food 15 mins. later. I see in my readings here that BG in the 50s is not treated as a serious low. What number do you give karo syrup and at what point just feed instead of glucose? confused_cat
 
Hi Linda

just took a peek at ur SS, have you retested the 58 since +4?

50's is not a serious low, but it is a range u want to monitor.

How is Tasha doing?
 
Just had the +4 less then an hour ago. I just gave her some wet food and will check her again shortly. I think I am having trouble with the new syringes with the 1/2 scale marks. Maybe I am making her shot too big? Maybe I was giving her more like .15 before not .25? It is all so small it looks like nothing in the syringe to me.

Tasha seems to be doing very well. I think she put the weight back she lost. She doesn't feel quite as light as she has been and I am happy about that.

Most of her pre shot numbers are not on an empty tummy. Because of my circumstances I am making it to coincide with the time I am home. She gets her shots at 10 but eats at 8 or sometimes after, so it is not a 2 hour fasting BG like it should be. But, that is when she wants to eat and she is not a big eater so I comply.
 
Thanks for the link Gayle! I think I have been giving .3 sometimes and maybe .1 other times. I guess the number doesn't matter as long as what I am doing is consistent. I need better glasses I think.
 
Linda, I think it just depends on the meter you are using for testing. If you are using a meter calibrated for feline then the numbers you should be working with are different than if you are using a glucose meter calibrated for human blood. If you are using a meter calibrated for human blood, then you can expect the reading to be 30-40% lower than actual when testing a cat, that is at the lower range. So if you are getting a reading of 50 the actual blood glucose is really more like 70 - 80. And that isn't a danger zone for a cat or a person for that matter. Hope that helps.
 
The information that Tina provided isn't accurate. If you want more information, please look at this link from Jacquie Rand's studies - she's a veterinary clinical scientist who has been doing groundbreaking research on Lantus in felines. The information is actually in the starred note at the top of the Board in the "New to the Group" announcement. It's toward the end of the post in the section entitled, Protocols for Use with Lantus and Levemir. Rand states:

Rand et al. said:
The blood glucose values were based on using portable glucose meters (Ascensia Contour, Bayer, Leverkusen, Germany; Accu-Chek Aviva, Roche Diagnostics, Basel, Switzerland) which use ≤0.6 μL of blood per test. These meters measure blood glucose concentration in whole blood and are calibrated for use with human blood. Measurements from meters calibrated for human blood which provide plasma equivalent values are approximately 10% higher
 
Sienne and Gabby said:
The information that Tina provided isn't accurate. If you want more information, please look at this link from Jacquie Rand's studies - she's a veterinary clinical scientist who has been doing groundbreaking research on Lantus in felines. The information is actually in the starred note at the top of the Board in the "New to the Group" announcement. It's toward the end of the post in the section entitled, Protocols for Use with Lantus and Levemir. Rand states:

Rand et al. said:
The blood glucose values were based on using portable glucose meters (Ascensia Contour, Bayer, Leverkusen, Germany; Accu-Chek Aviva, Roche Diagnostics, Basel, Switzerland) which use ≤0.6 μL of blood per test. These meters measure blood glucose concentration in whole blood and are calibrated for use with human blood. Measurements from meters calibrated for human blood which provide plasma equivalent values are approximately 10% higher

Seinne and Linda.

It might be a good idea to read the whole section. Because I think what I said was accurate, but again it all depends on the meter that you are using.

Rand et al. said:
NB. The blood glucose values were based on using portable glucose meters (Ascensia Contour, Bayer,
Leverkusen, Germany; Accu-Chek Aviva, Roche Diagnostics, Basel, Switzerland) which use ≤0.6 μL of
blood per test. These meters measure blood glucose concentration in whole blood and are calibrated for
use with human blood. Measurements from meters calibrated for human blood which provide plasmaequivalent
values are approximately 10% higher.

NB. It is very important to note that blood glucose concentrations measured using a whole blood
glucose meter calibrated for human blood may measure 30-40% lower in the low end of the range than
glucose concentrations measured using a serum chemistry analyser or a plasma-equivalent meter calibrated
for feline use. Therefore, if using a meter calibrated for feline use (eg. AlphaTRAK, Abbott
Laboratories, CA, USA), or a serum chemistry analyzer, add approximately 30 mg/dL (1.7 mmol/L)
to the target glucose concentrations (see Table 3B). For example, a target > 50 mg/dL (2.8
mmol/L) becomes > 80 mg/dL (4.4 mmo/L) when using a meter calibrated for feline use. Instead of
aiming for 50-100mg/dL (2.8-5.6 mmol/L) , aim for 80-130 mg/dL (4.4-7.2 mmol/L [round numbers
4.5-7.0 mmol/L). Meters calibrated for feline use may read higher or lower than the actual value, in
contrast to consistently lower readings for meters validated for human blood.
 
To Tina & Sienne,
I see no mention of any difference in feline blood to human blood in those quotes. Only in whole blood and blood plasma. As the parent of a Diabetic child , by using a BG meter I am taking whole blood. The same goes for when I check the cat. I am not taking blood plasma from her either. I am taking her whole blood.
I was told the normal range for cats and humans are the same and the meters read the same when checked side by side to the "pet" meters.
Sorry I reread that and see it now. Hmmm must have missed that the first time I read it.
 
Linda:

You're correct. And more to the point, I'm assuming you are using the same meter to consistently test. I think the discussion would be relevant if you were going between different meters. (Sorry - didn't mean to hijack the question.)

To answer the question you initially raised, I agree with Ronnie. A reading in the 50s is generally a "pay attention." It also depends on where in the cycle that number falls. If It is a sharp drop early in the cycle, I'd be very attentive and test more frequently. If it was late in the cycle, there's less of a concern since, as you know, it's likely that numbers will be heading up on their own. Numbers under 50, if you don't yet have data on how your cat responds to being steered with food, are points where you definitely need to be attentive. Those are times for a new Lantus user where we suggest testing every 15 min. and feeding either LC or MC food to bring the numbers up into the 50 - 70 or so range. We want to encourage a surf in those mid-range green numbers to promote pancreatic healing and to increase the liklihood that these numbers will once again be recognized as "good" (i.e., reduce the potential for rebound). Numbers under 40 we generally recommend feeding HC in a small amount (1-2 teaspoons) to bring numbers up to the aforementioned range.

Does that help to explain?
 
I would think if numbers were in the 40s you would do better with a quick sugar then check in 15 for a raise in bg and feed with LC wet food to prevent a crash and to maintain the level. Much of what I know about diabetes in people can be applied to cats, just not everything I guess. I treated Tasha's 58 with LC food and she went up to 169 an hour later. If this was my daughter I would have had to give her glucose tabs at that much of a low. Followed of course by a protein and carb 15 mins. later when her numbers were up.
 
Linda and Tasha said:
I would think if numbers were in the 40s you would do better with a quick sugar then check in 15 for a raise in bg and feed with LC wet food to prevent a crash and to maintain the level. Much of what I know about diabetes in people can be applied to cats, just not everything I guess. I treated Tasha's 58 with LC food and she went up to 169 an hour later. If this was my daughter I would have had to give her glucose tabs at that much of a low. Followed of course by a protein and carb 15 mins. later when her numbers were up.

Yes, you are correct a quick sugar is sort of what you would be doing with the HC. Based on what you have said about Tasha' going from 58 to 169 in an hour after LC, it is very likely that Tasha is carb sensitive and LC food is all you would need to bring up a low. But I highly recommend having some HC on hand just in case. Also I have learned that when feeding a low you don't want to feed too much at one time just in case the low continues to drop. Last week Sami was below 50 and I allowed her to eat 1½ cans of Fancy Feast, and when her number continued to drop she wasn't very interested in eating any more. So now when she is low I give her a small amount of HC and then test an hour later. At first I had to test no more than 30 minutes later, but now that I have lots of data on how Sami responds I don't have to test quite as often during a low.
 
Tina,
I know I don't have experience in cats, but in people you don't just feed a HC with a low. You give a fast carb. I think the fancy feast had too much protein in it and that slows down the spike you would get form the carb in the ff. You gave her a can and a half. That is how it works with people so I would think it would be similar in cats. In other words if my daughter had a low, I wouldn't give her bread with peanut butter (fat & protien) which slows down the carb from working. Even though it is a carb., it is a slower carb and keeps her bg from rising up quick enough. It also may not stop her from going lower either because of this. I would give her a quick sugar like juice (karo for a cat & wait 15 mins because the bg would come up very fast, then slow it down with a small portion of pb and bread (Fat, protein & carb) Actually, only a fat & protein would be needed. Maybe that is why she didn't come up fast enough. The larger amount of ff was preventing it. I would think a fast carb over a High carb for a low would be the best choice if the low was very low. Just like in people. It kind of sounds like it to me, but I may be wrong.
 
Linda and Tasha said:
Tina,
I know I don't have experience in cats, but in people you don't just feed a HC with a low. You give a fast carb. I think the fancy feast had too much protein in it and that slows down the spike you would get form the carb in the ff. You gave her a can and a half. That is how it works with people so I would think it would be similar in cats. In other words if my daughter had a low, I wouldn't give her bread with peanut butter (fat & protien) which slows down the carb from working. Even though it is a carb., it is a slower carb and keeps her bg from rising up quick enough. It also may not stop her from going lower either because of this. I would give her a quick sugar like juice (karo for a cat & wait 15 mins because the bg would come up very fast, then slow it down with a small portion of pb and bread (Fat, protein & carb) Actually, only a fat & protein would be needed. Maybe that is why she didn't come up fast enough. The larger amount of ff was preventing it. I would think a fast carb over a High carb for a low would be the best choice if the low was very low. Just like in people. It kind of sounds like it to me, but I may be wrong.

hello linda. i think part of the problem here is comparing cats to people. feeding a high carb canned food or the gravy from a high carb canned cat food works very well at raising numbers with cats. we steer away from using karo/syrup unless we have to. you can see numerous examples of how well this method works by visiting the condos (threads) of kitties in low numbers.
 
Linda and Tasha said:
Tina,
I know I don't have experience in cats, but in people you don't just feed a HC with a low. You give a fast carb. I think the fancy feast had too much protein in it and that slows down the spike you would get form the carb in the ff. You gave her a can and a half. That is how it works with people so I would think it would be similar in cats. In other words if my daughter had a low, I wouldn't give her bread with peanut butter (fat & protien) which slows down the carb from working. Even though it is a carb., it is a slower carb and keeps her bg from rising up quick enough. It also may not stop her from going lower either because of this. I would give her a quick sugar like juice (karo for a cat & wait 15 mins because the bg would come up very fast, then slow it down with a small portion of pb and bread (Fat, protein & carb) Actually, only a fat & protein would be needed. Maybe that is why she didn't come up fast enough. The larger amount of ff was preventing it. I would think a fast carb over a High carb for a low would be the best choice if the low was very low. Just like in people. It kind of sounds like it to me, but I may be wrong.

I think we are talking about the same thing just using a different language. I also know about hypoglycemic issues in people as I have been known to have low blood sugar myself, not related to insulin injections, just my natural body producing too much insulin at times. Usually when I have a low I drink orange juice, and then follow it up with peanut butter crackers or sandwich with a glass of milk. I think with a cat the higher carb food helps to bring the sugar up more quickly, and the protein in all the food helps to stablize it so it doesn't drop as quickly. You can use Karo instead of HC, but my cat in particular won't eat anything sweet, so the small amount of HC works for us.
 
One thing I did learn with my daughter. If it works, do it. So, whatever works for you might not work for someone else, but as long as it works for you that is all that matters. I imagine that cats like people all respond differently to treatment. White potato and bagels all seem to make BG rise in people, but not my daughter. Most can eat shredded wheat, but she goes sky high on it. We all have to find what works best for our kitties and learn that it might not work for all kitties as well.
 
(((Monique)))

I love reading your posts. I am a facts kind of girl and I love to understand the deails behind how things work.

Thanks you so much for taking the time to educate us.
 
Thanks for that post Monique! The meter I am using for Tasha is one of my daughters and no one ever mentioned any change i meter readings from whole blood to plasma and there have not been any significant changes in my daughter's readings. The meters are maybe 3 years old. She got updated ones then of the same kind and uses 2 or 3 meters as back ups. There are the one touch meters. I still see the meters she has being marketed. Interesting.Perhaps they re recalibrated. I don't think hers are. I will look into it.
I am aware that a cat's metabolism is twice as fast as peoples. Hence the Lantus only working for 12 hours instead of 24. I just thought that it might be similar if bg tumbles and eating isn't curtailing the tumble it might be what is being fed. Sugar works for people and cats in raising bg quickly and both need a snack to follow that raise once the numbers come up. I was told that in regards to cats (unless I was told wrong) and know that is true with people.
It is hard to decipher what is true and what isn't because I hear many conflicting things. I do have an open mind to a new way of thinking, but I think some of what I have learned over the past 18 years might be helpful as well. I may well find that up is down so to speak when it comes to kitties. I am sure I will learn as I go along what works for us and what doesn't work. Thank you all fr your input.
 
@Ronnie, Tasha is doing great. Does everything and gets into trouble as always. Thank you for asking. We do have a little bit of trust issues going on when it is time to check her numbers. Other then that she is the same loving kitty. cat_pet_icon
 
Thanks again Monique for all the info. Actually, my daughter's insulin needs are constantly changing and she has the occasional lows as well. This is because she is a professional dancer and her rehearsal and performance schedule is always changing so her "exercise level" is never constant. It has been quite an experience helping her through this as a child to adult hood. We had to learn what worked and what didn't along the way. She was doing 30 hours of dance class a week. She was on an insulin pump for awhile and disconnected when she danced but that didn't work out well and she is now on Lantus with novolog for food. Luckily I use her test strips and insulin for Tasha and there is always an overlap in supplies to cover the cat.
I believe I caught Tasha's diabetes quickly. Less then a month after she showed symptoms of excessive thirst and urination. The highest reading when dxd was 368. I am hoping she is one of the lucky ones who will eventually go into remission. She is getting .25 units BID and I am working toward getting her feeding after her shot which has been difficult because she never was a big eater and could go off food very easily. I have to give her her shot at 10 because often I am not back until that time to give her her second shot. Today i was successful this morning although she did eat a little of her left over food from the night before around 9 AM. It has only been a little more then 2 weeks we have been doing this. So if you look at her number AMPS and often PMPS they are after 1 hour of being fed. The 2 entrys (one in the green and the other today in the blue) were closest to true readings due to her feeding schedule. She is not crazy about the change in diet, so I am happy that she is eating when she eats.
I am looking forward to your help and guidance along the way. Thanks again for all the information.
 
@Gayle, sorry for bringing up human diabetes, but that is my personal point of reference for learning. I have dealt with it for 18 years and having a comparison does help me understand the differences. If I didn't bring up what I know, I would assume some wrong thing regarding feline diabetes and by bringing it up it has been helpful to me in understanding how things work differently. I realize it has little value for you, but for me it is very helpful to discuss comparison. Especially since my kitty was just recently dxd.
 
Linda did you read the information above in this forum...New to lantus etc. You can start a "condo" thread for Tasha each day with your BG readings like everyone does here. I'm sure Tasha has a great chance at OTJ. As far as eating if she is picky you just have to let her eat when she will, some cats don't do things our way :roll: .25U is a very small dose and if that is bringing her nice green numbers then she shouldn't be too long here!
 
Linda and Tasha said:
Tina,
I know I don't have experience in cats, but in people you don't just feed a HC with a low. You give a fast carb.

Linda, HC *is* a fast carb in cats, the Karo is just faster. Unfortunately it is short lived and difficult to predict as well. When it wears off, your cat could be right back where he/she started with no warning. The HC bumps fast and hangs around for a little while gently lofting the numbers up while the owner goes to plan B (Karo) only if the the HC fails for some reason.. which is actually fairly rare. The HC catches it just about every time, assuming the owner wasn't taken off guard by a surprise LO. Like Jill said, when you see someone post a low number, go watch their condo. It's like watching reality tv, you see the excitement, the treatment, and the results unfold right in front of you. Far less anecdotal that way. :)
 
Gayle and Shadoe said:
Just wondering but why are we talking apples and oranges here?
What has human diabetes got to do with feline diabetes on a diabetes board? What's the normal temp for a human and for a cat? They are different.
How come Lantus is once a day for humans, but twice for felines?
I am not here for human diabetes talk; I need to learn about feline diabetes.

I have a friend, human, who is using less Lantus than my cat, but I am here for support for my cat.
Who cares! She is not a cat!

What's all this meter talk anyways?
I don't have any feline meter; I have just a regular human one that I got at Walmart.
It's a meter. It works.

I have edited my contributions to this subject matter and I will use my time more wisely in the future. From now on any opinions or information I will not back up with any indepth material on the matter. A simple explaination is....it's a god damn meter, who cares! We all use it and it's good enough no further explaination needed. When giving advice I will support or explain my reasoning in the simplest manner......Because I said so! Because that's how everybody does it! If you want to know more check my spreadsheet, how long I've been here, or wait for someone to send a PM to another member to summon them here for a second opinion.

Good luck!
 
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