Help! Some assistance on Insulin Please

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Lauren Cox

Lauren Cox

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Let me give you a little info on Izzy our diabetic cat! She was diagnosed back in February of this year. When I brought her in our vet said we should just put her down she was very dehydrated and her blood sugar levels were above 600. My husband and I refused. She was fine just a few days before we brought her in (other than excessive drinking and urination signs we now know are diabetes). We refused to put her down and asked that she be hooked up to IV and monitored. after 4 days back and forth to vet and overnight care at animal hospital we nursed Izzy back to health and started an insulin routine. I dont agree with a lot of what the veterinarian has been saying about upping her insulin too fast and in 1 unit increments. I have done so much research on this forum that i feel more knowledgeable than our vet.

We have been home testing for months now pretty regularly but backed off of doing it but every 2 weeks since she was regulated on insulin (4 units 2x day) with consistent numbers in low 200s. We switched her completely over to Friskies Pate 1/2 can 2x a day 3 weeks ago. We insulin her (Prozinc) while we feed her morning and night.

On 4/30 she went into hypoglycemic shock out of the blue at about 11:55pm that night. She hadn't eaten that well that night (a few bites) but other than that she was completely normal. It was one of the scariest nights of our lives! We tested her right away and she was at 20! she was laying on the floor screaming and kicking all her legs so first instinct was to grab the karo syrup and get a Tbls down her throat. It was a mess, difficult to pry her teeth open but we got some down and tested every 20 minutes as her glucose level began to rise. After about an hour and a half she thankfully came out of it and she was able to eat a full can of cat food. The mystery was.....WHY DID SHE GO INTO HYPO? Was it due to changing her completely over the friskies pate and eliminating all dry food and treats? Was it because she hadn't eaten much that evening? Now we know we need to test more regularly.

We took her to vet next day for monitoring and her glucose level was 530 in morning so they gave her 4 units of insulin. I was nervous about this after her Hypo episode just 8 hours earlier. Then when she left vet her number was at 96 and i was instructed to give her 2 units 2x a day starting that evening. Right away i questioned giving her 2 units when her blood was only 96. The vet said well than give her 1 unit tonight and start on 2 units in the morning 2x a day. Still was uncomfortable with giving her insulin with that number and when i tested 3 hours later before her insulin she was at 46 so i decided to NOT give her insulin that night and monitored her.

Moving forward we are giving her 2 units 2x a day and we are taking testing more seriously and would like any input on her numbers (see attached chart) and if we are giving her proper dose of insulin. Her appetite is great in the mornings but her evening feeding is hit or miss and it worries me when i give her insulin when she doesn't eat but a few bites of food.

Thank you in advance! ANY input would be wonderful. This forum is a blessing and look forward to getting Izzy on the right track.
 

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Wow! That's quite a ride you guys have been on! Thank heavens you were home testing and knew what to do when that hypo happened!

We can definitely help you get Izzy on the right track safely. First, I have a question for you. Looking over your chart, it seems that you shoot at different times. We recommend shooting every 12 hours. Are the reasons for the changing times due to the BG numbers or is it your schedule?

I would say to start with to NOT shoot under 200. You can try stalling for 20 minutes WITHOUT FOOD and retest to see if she comes up. If you can't do that for some reason, just skip the shot. Better high numbers than too low! If you're unsure what to give, please feel free to post here...we'd be happy to advise!

As for why the hypo happened, it could be a number of things. My guess is the dose was too high (as you said, being raised in 1 unit increments is way too much...we usually do 0.25) and the food change combined to really drop her. Low carb wet food can drop cats numbers over 100 points overnight!

As for not eating....that can be an issue. As long as you get SOME food in her, you should be able to give a shot. Is there any way you can get her to eat more in the evening? Does she not like the food or is she just not hungry? You could try putting some forti-flora on it or some crushed up treats to get her to eat more. She doesnt' have to eat her whole meal then (we have lots of grazers) but she does need to get a few tablespoons in probably.

I don't want to overwhelm you with too much right now. 1 more thing...can we get you to set up a spreadsheet like we use here to help us help you? It's what we're all used to reading and it gives us the chance to see how Izzy is doing quickly and easily. I'll grab the instructions and post them in a sec. :)

What other questions do you have?
 
Thank you Rachel! As for the schedule we try to stick to every 12 hours but sometimes we delay based on her not eating much right away or if her numbers are not quite right. I'll check out the spreadsheet and see about converting it over this weekend. Great info! Do you think the 2 units is a good number at the moment? We wont give her insulin unless she is above 200. :)
 
Hmmm...that's a hard one. We usually start at 1 unit, but you've already been at 2 units and you're getting some okay numbers on that. Looks like you gave 2 units this morning. Could you get some mid cycle tests today? Anything you can grab would help, but something in the 5-7 hours range (nadir or mid cycle) would be super helpful. We generally recommend doses based on how low they go at mid cycle and what the preshot is. Armed with that info, we could probably determine if 2 units is too much or not. My gut feeling is that it might be and you're seeing some bouncing, but I have no way of knowing that for sure. :)

If you need help with the spreadsheet just let us know! We have a few tech gurus who hang out here and can definitely get it up and running if it gives you problems.

Side note, what time zone are you in? I'm going to be out later this afternoon, and though I'm sure others will be around at your PMPS time, it's nice to know when to check in on you.
 
Rachel has given you some great advice, so I'm just stopping by to say hi and second everything she said! Welcome! :)
 
Oh no!!!
Im using a One Touch Ultra Mini glucometer! I just tested and her numbers are low! This is 4.5 hours after eating and her insulin. I tested 3x in a row. 39, 41, 52! 52 being the last time i tested her. I decided to give her some friskies pate and she's eating it.

BTW: Thank you so much to you both for your quick responses! What a loving community! My time zone is Eastern Daylight. From Virginia!
 
If you can, please take away the pate for a minute. You may need her to eat some high carb food and don't want her to be too full to eat.
 
Lauren Cox said:
Oh no!!!
Im using a One Touch Ultra Mini glucometer! I just tested and her numbers are low! This is 4.5 hours after eating and her insulin. I tested 3x in a row. 39, 41, 52! 52 being the last time i tested her. I decided to give her some friskies pate and she's eating it.

BTW: Thank you so much to you both for your quick responses! What a loving community! My time zone is Eastern Daylight. From Virginia!
Click to expand...
OK. Here's the plan:
  1. reduce the dose to 1 u twice a day starting next dose
  2. start our recommended testing routine: every AM and PM before feeding and giving insulin (no food 2 hours before). at least one other mid cycle and/or before bed test and any extra tests you can get on days off
  3. set up the spreadsheet we use here
  4. post for advice as often as needed.
Make sense? :)
 
Okay, just re-read. Looks like 2u, 4.5 hours ago, correct? Do you have any of her old higher-carb food?
 
If so, I would say to give her a tablespoon of that. If not, then add a bit of honey or karo to the regular food and give her that (still just a tablespoon or so). You may need to repeat this, so again, getting some carbs into her, but not filling her up just yet.
 
Kris & Teasel: When should i feed and insulin her? I usually do them at same time. I saw you said no food 2 hours before. Thanks!
 
Here's the sequence for steering low BG upward with food: test, if low give a small amount of HC food, wait 20 minutes, retest and post result, if still low give a bit more HC, wait 20 min, retest and post, etc.
Lauren Cox said:
Kris & Teasel: When should i feed and insulin her? I usually do them at same time. I saw you said no food 2 hours before. Thanks!
Click to expand...
Sorry for not clarifying. The AM and PM BG tests have to be non food influenced. The AM and PM sequence is:
  1. test (no food has been eaten for at least 2 hours before this test) to see if the planned dose is safe
  2. feed - even a tablespoon or two is enough
  3. inject insulin
The same sequence is followed at night. The other mid cycle tests are needed to see how low a particular dose takes the BG - like today! ;)
 
Just to clarify: Kris' first sentence about the high carb (HC) food is regarding right now.

The rest of her info is regarding a normal cycle.
 
Yes my laptop is up and open on this page so he can post! Thank you so much everyone. Down to 44 now. Giving more high carb dry food
 
Do you have any wet food? Dry food takes longer to process. If that's what you have though, go with it. Do you have any honey or karo syrup?
 
Considering all that's happened, I strongly encourage the reduction to 1 unit as well. My gut told me this morning that your kitty was bouncing, and I think that was right. Those low numbers are obviously too low...so a reduction is DEFINITELY in order!
 
Thank you Djamila and Rachel. I just tested before eating (been at least 4 hours since she ate something) and got 493. Gave her half a can of friskies and gave her 1 Unit as recommended! I'll test again in the morning before I feed and give her insulin. Should i test again tonight before bed just in case?

Thank you Thank you Thank you all!!!
 
I definitely would test again before bed! How far away is that for you? A +2 would be great as the food should be wearing off and that would give you a good idea of if she might start dropping again. :)
 
I can test tonight at +3 before I head to bed. I'm up with a newborn throughout the night so I may try and test Izzy during the night to be sure. Spreadsheet and signature set up :)
 
Sounds great 337 this morning before eating and insulin. I'll stick with 1 unit doses. Thanks everyone. We'll see how it goes. Fingers crossed.
 
Hello all! I wanted to check in with everyone and see what you thought of Izzy's spreadsheet and numbers? She's been averaging in the 400's and 300's during Nadir. but on occasion her numbers would be in the single digits which is very odd to me. I get so nervous she'll have another episode. Thanks in advance to anyone that can help. You all have been so helpful during this journey. Have a great night!
 
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