How to Handle Hypoglycemic Numbers for Feline Diabetics, Diabetic Cat Care

The information contained in this sticky is provided for educational purposes only and is not intended to replace veterinary advice. The intention of this sticky is to open doors to understanding about the specific medical condition or topic, allowing for educated and on-going discussion with your vet.

Diabetic Cat Care

How to Handle Low Blood Glucose Numbers

If you see a low BG, don't panic! Follow these instructions.

The first thing to do if you've tested and find your cat's BG low is to immediately retest to confirm or deny whether or not the test result was a fluke. If the second test confirms the BG is in fact low (below 2.2/40), then give your cat a teaspoon to tablespoon of food right away, test again in 15 - 30 minutes. If the BG is still low; wash, rinse, repeat every 15 to 30 minutes until the BG starts to rise.

Please remember, if the TR protocol rules have been followed - your cat has been safely detoxed, is being fed low carb WET food only, and BG is always tested before shots; symptoms of clinical hypo, like seizures for example, are extremely rare in otherwise healthy cats.

Something else to keep in mind is that human meters, when in lower numbers, tend to read a bit higher than the BG actually is, for example if you have a reading of 27/1.5, the BG is supposed to be higher than that. This is apparently a protection for humans, so they're aware they are dealing with very low numbers and need to deal with them right away. It's the same for our cats - we need to be attentive, monitor frequently and be responsive with food until their BG starts to rise.

If you are frightened, need some support, or just want some company during a low, please post on the Talking TR forum and your fellow members at DCC will help guide you through. There's not one of us who doesn't remember how scary our first experience with low BG was, even though we laugh about it now.

We want you to understand how to deal with both non-symptomatic low numbers and symptomatic hypos in a carnivore-friendly manner. Please print out this sticky and keep it in a place where you can put your hands on it right away should your cat drop to lower than aimed for BG (below 2.2/40).

Dealing With Low Numbers in a Carnivore Friendly Way

While low numbers are typically not a critical situation, they do require your attention and assistance to provide low carb wet food and continued monitoring of your cat’s BG until it rises above 2.8/50, and as well, until the insulin's nadir is past.

What are Low Numbers?

When practicing TR we aim to keep our cat’s BG within normal non-diabetic range (2.8/50 to 8.3/150) for as much time as possible. Because we cannot predict when the cat’s own pancreas will kick in, or how medications, other health issues, or changes in diet will affect the BG, sometimes our cats drop into low BG, numbers below 2.2/40, or even to a reading of LO on your glucometer. While we don't aim for low BG and they sometimes happen, low numbers aren't something to be afraid of when it comes to TR. In many cases, it means there's healing going on inside, and it's possible lows might even spark You Know for your cat. Remember, the goal of TR if at all possible is to navigate FD cats into diet controlled diabetic remission - aka OTJ.

Most vets have no idea of what the BG actually is for non-diabetic cats. Think about it, stress raises the BG, cats at vet visits are typically highly stressed, so what the vets typically see is BG artificially elevated by vet stress (similar to White Coat Syndrome humans experience). It is not at all abnormal to see the BG of a stressed cat as high as 16.7/350 if not higher! Because blood work is usually done in a stressed state, some vets have come to believe normal range BG for cats is in the 250 - 300/13.8 to 16.7 range. This is far from the truth. Please, to help alleviate your fear of low numbers, test your other cats, or test a friend's cat's blood sugar. Once you see for yourself where a non-diabetic cat's BG rests in the comfort of their own home, you'll be much less fearful.

The Liver’s Job - Why the Liver Needs to be Wide Awake

The liver's main function is to keep the cat safe from clinical hypos from low BG by stimulating glucose production. When a cat is being fed dry/high carb food keeping the BG constantly high, the liver becomes accustomed to those high numbers and basically goes to sleep, no longer able to do it's job. Once the dry/high carb food has been removed from the diet, over a three day period the liver "wakes up" and will resume its most important function, kicking out glucagon to protect the brain. If you give syrup or high carb foods to low BG with no symptoms of clinical hypo, you run the risk of putting the liver back to sleep, resulting in your cat being at continued risk of clinical hypo potentially for three days. TR is a very safe protocol once a cat receiving insulin has gone through the Detox Process from high carb foods - if you've already gone through a detox, unless absolutely necessary, what's the point of compromising the liver again?

What Can I Expect When My Cat Drops Low?

Typically, you won't notice anything too much different about your cat or their behavior when their BG drops low. More often than not you'll only find out because you've taken a mid-shot test. Most cats appear quite fine, although it is possible they might start begging to be fed, they may become a little more vocal and perhaps pace a bit more than normal. Some of us with cats who are long term diabetics have learned to distinguish their "I'm low mum" meow. Some cats even come to let us know they want to be tested. If out of the blue your cat displays any of those signs, sliding in a test to find out their BG is always a good idea.

How to Feed Lows

Feed your cat a small amount of low carb wet food, a tsp to tbsp to start. You do not want to overfeed as you need your cat to continue to eat frequently if necessary for as long as their BG stays low (below 2.2/40). If your cat has dropped to LO on the meter, then it's wise to test every 15-30 minutes until the BG starts to rise. However, if not LO on the meter, test every half hour to an hour until the BG rises over 2.8/50.

Giving food is not used to raise the BG significantly, this is why you don't want to feed too much at one time. Feeding is used to blunt the BG from dropping further, and most importantly, to provide needed fuel to the liver so it can do its job of normalizing the BG and protecting the brain, which as explained above is the liver's job. We recommend keeping a can or two of higher carb wet food (approximately 10% dry matter carbs) in the event your cat might have what we refer too as a stubborn low. Stubborn lows can occur as a result of dosing too early (or too much) by mistake. If it happens that you've dosed early, or given too much insulin, please post on Talking TR right away as members can help you navigate through a potentially extended and/or stubborn low.

Hypoglycemic Seizures

In very, very RARE cases, it is possible seizures can occur. This is not a normal occurrence by any means - even if a cat might have low level liver issues. If the cat is seizing and is still able to eat on its own, continue testing/feeding as necessary. A trip to the vet is warranted if seizures continue after food is given and the BG starts to rise. It is important your vet understands the principles of dealing with low BG when practicing TR, so you will want to explain the reasoning behind not administering glucose IV drips unless absolutely necessary.

For a seizing cat that cannot/will not eat, apply a small amount of syrup or honey to your finger and massage it into your cat’s gums; this should bring your cat to the point where they can resume eating on their own. In very rare cases should this not work, then a small amount of syrup or honey mixed with a tsp to tbsp of water can be administered rectally with a baby medication syringe (one with no needle, looks like a mini turkey baster). In the event of an unresponsive seizure or coma, take your cat to the vet immediately! Ask your vet to administer Valium to stop your cat’s seizures, and once seizures have stopped, for the vet to tube or syringe feed low carb wet food. Request that NO IV Glucose/Dextrose be given, as this will put the liver back to sleep. When syrup, honey or IV glucose/dextrose have been used to deal with a clinical hypo, then a very carefully guided Detox Period will be required afterwards. Members will be able to provide guidance to you about how and when to start back with insulin doses as well as what adjustments should be made to your cat's dosing scale.

My vet told me to make sure my FD cat eats before giving shots of insulin, how come we don't do that on TR?

No doubt when your cat was diagnosed FD, your vet instructed you to make sure that your cat eats first before giving any insulin shots. The reason for this is because most diabetic cats are being fed both high carb dry kibble and/or high carb wet foods. By making sure the cats eat prior to insulin injections, the hope is that symptomatic clinical hypos can be avoided. Unfortunately, following this advice doesn't work when it comes to preventing clinical hypos and is actually counter-productive.

Most vets do not understand the BG of non-FD cats rest between 2.5/45 and 6.6/120. Because of the stress of car rides and vet visits, the BG of most cats are significantly elevated by the time the vet sees them at the clinic, and as a result, vets consistently assume these high BG are normal for all cats. They are NOT! As a result, there's a fear of what the veterinary community believes are low numbers - usually somewhere between 7.0 to 11.0 / 135 to 200. These are not NORMAL BG for cats - unfortunately unless a vet decides to test their own cat - diabetic or not - they very rarely understand what purrfectly normal BG for cats really is.

In addition, most cats the vets see are being fed dry kibble and high carb wet foods. Because many high carb fed diabetic cats DO have seizures, the vets will insist that unless food has been eaten before, you shouldn't give an insulin shot. The reason for this is the knowledge that feeding high carb food will raise the BG in an effort to prevent a clinical hypo. The truth is, on TR food isn't tied to shots because our cat's livers are already wide awake and ready to work to prevent an asymptomatic hypo. We feed when its meal time, or when the BG is lower than desired (below 2.2/40).

After you’ve had your first experience with a low BG and have seen for yourself that your cat is fine (other than perhaps being hungry, a bit noisy or pacing a bit), we hope you will not have a fear of low numbers again. It is those beautiful, healing ideal range numbers between 2.8 and 3.8 / 50 to 70, which allow for the pancreas to resume function again and then, if at all possible, for diet controlled diabetic remission to happen. While we don't aim for low BG - they do happen at times. Remember, the lows are much better than the highs any day!