Hypoglycemia

[Sarah Lee]

My cat Ram Jam is an 11 year old solid black male baby boy cat.

He was diagnosed with diabetes approx 4 years ago with glucose present in his urine and a glucose reading >700. He was put on Lantus 1 unit twice daily for about 6 months and moved to a strict diet of authority catfish pate. He went into remission and has been diet controlled since 2013.

Recent visit to the vet and a low carb kibble diet was discussed. A normal fructosamine was resulted and we started on a kibble twice daily that was 26% carbs. A chemistry panel was drawn 5-7 days later pre-procedure and his glucose was 450.

Procedure was cancelled and we took him home with a script to start Lantus 1 unit bid if his sugars did not decrease in 4 days.

I gave ram Jam about a week back on his pate and his glucose ran in the 300s. Speaking with the vet we decided on the insulin.

Picked the insulin up yesterday morning and rams had a sugar or 232 but was with me in bed all night so did not eat anything. I administered the 1 unit at about 2pm 9/19 and fed him his authority pate. We put 2 cans of wet food out every 12 hours. We have 3 cats.

Wanting to get on a better schedule I decided to hold his insulin until about 0800 Am.

Checked his sugar at 0200 9/20 ( 12 hours post administration) and his glucose stick was 55. I fed him about 1/4 cup of dry food and got his glucose up to 78 in 30 minute recheck.

This is frustrating. I absolutely don't want to give him more insulin but his sugar wasn't controlled before.

Any suggestions?

 

[Tricia Cinco(GA) & Harvey]

Hi Sarah, and welcome. Some quick questions. What kind of meter are you using? Human or pet? What kind of kibble did you give him? The 26% carbs? Where are you located? You don't have to be too specific - I just need to know at least your time zone and country.

 

[Sandy and Black Kitty]

This is frustrating. I absolutely don't want to give him more insulin but his sugar wasn't controlled before.

He went into remission and has been diet controlled since 2013.

Recent visit to the vet and a low carb kibble diet was discussed. A normal fructosamine was resulted and we started on a kibble twice daily that was 26% carbs.

I'm confused.
He was in remission since 2013-
fructosamine was normal-
Why was 26% carb kibble started?

 

[Tuxedo Mom]

I also am very confused with the same questions @Sandy and Black Kitty has asked.

If Ram Jam was diet controlled and had a normal fructosamine, then WHY on earth would the vet suggest something that was more or less guaranteed to take him out of remission. Once a kitty is able to go into remission they MUST continue eating wet low carb food for the rest of their life to avoid a reoccurence of FD.

Considering how low the glucose levels were 12 hours after the shot is very concerning. Wondering just how low he went during the cycle.

My thought would be to trash the dry food...not good for any kitty, let alone a diabetic in remission....stick with the LC wet food...hold the insulin and do some spot testing to see where the glucose levels are. Ideally try to get a fasting test...at least 2 hours with no food...a test about 2-3 hours after eating and a couple more random ones.

Unless I am reading this wrong...it is a case of "if it works, don't fix it" You have given no insight WHY the vet wanted you to change to a HC dry food, so this is very confusing.

 

[Sarah Lee]

I'm in central Florida. The brand is authority but it was specifically authority chicken and rice hair ball NOT weight control hair ball, the weight control was higher carbs. This stuff was lower carb than the diabetic RX kibble.

We have been using a relion micro to check his sugar twice daily. This insulin administration was his first in several years.

I woke up to check his sugar 3 hours after the reading of 121 and it was up to 301.

I'm not sure he needs the insulin. Can you give 1/2 unit? If so how?

The kibble was started back because firstly he really really loves it, secondly his brother booger literally starved himself down 4lbs when we swapped to pate. He just won't eat it so we are constantly chasing my orange tabby around with a Tupperware container of kibble letting him eat then closing it before rams can get it etc.... it's hard for rams to see and smell it too. So we'll say overall ease of care.

 

[Sarah Lee]

Yes ma'am. Since the first elevated glucose he has been strictly pate until he was hypoglycemic last night. He was awake and alert, moving around willing to at least eat a few bites of kibble. After his glucose came up to an acceptable level he has been given no more carbs And will not be.

I also am very confused with the same questions @Sandy and Black Kitty has asked.

If Ram Jam was diet controlled and had a normal fructosamine, then WHY on earth would the vet suggest something that was more or less guaranteed to take him out of remission. Once a kitty is able to go into remission they MUST continue eating wet low carb food for the rest of their life to avoid a reoccurence of FD.

Considering how low the glucose levels were 12 hours after the shot is very concerning. Wondering just how low he went during the cycle.

My thought would be to trash the dry food...not good for any kitty, let alone a diabetic in remission....stick with the LC wet food...hold the insulin and do some spot testing to see where the glucose levels are. Ideally try to get a fasting test...at least 2 hours with no food...a test about 2-3 hours after eating and a couple more random ones.

Unless I am reading this wrong...it is a case of "if it works, don't fix it" You have given no insight WHY the vet wanted you to change to a HC dry food, so this is very confusing.

 

[Sarah Lee]

Also he has been having his sugars checked regularly. They've averaged in the 300s. I try to check it before putting down a new plate of food 2 times
Daily. I work 12 hour shifts so it's usually about 0800 am and 5pm he is spot checked and fed. Here is a quick jot down of his sugars.

 

[Tuxedo Mom]

Thanks for the additional information.

As I posted above, the change to dry food was most likely the reason for the high glucose readings with Ram Jam and hopefully by going back to the LC wet the need for insulin will be removed. If you do some spot testing as I suggested above now that he is not getting the dry and find that the levels are still too high, you could try a smaller dose..possibly 0.50 unit. There are syringes with 1/2 unit markings that make it easy to measure this. If you only have the syringe with 1 unit markings then you would have to eye-ball the dose.

If Booger is being very resistant to eating wet food, you could try a mix of wet with crumpled dry on top to encourage him to try and eat the wet. I changed to all wet food over 10 years ago and had a heck of a time with my girlie kitty, who also could not afford to lose weight. With different tricks, such as the dry food "topping", tuna juice on the wet, etc I finally got her to an all wet diet. Given the option, even now, she would choose dry over wet, but she will eat the wet without problem.

There are some lower carb dry food such as Young Again Zero and Evo Cat and Kitten ( I believe) and Wellness Core. The one that most people with dry food addicts have had the most success seems to be the Young Ago zero. It is very expensive and has to be ordered online, but it is suitable for diabetic kitties as well so if Ram Jam got into it, it shouldn't cause spikes in the glucose levels.

 

[Sarah Lee]

Thanks so much for your thoughtful reply.

We've tried everything with boogs. He's neurotic. After our brief one week honeymoon with the dry food we switched back to all pate and tried
To use that as an opportunity to get the ginger cat off of the dry then. We were unsuccessful. He was starving himself. Ugh!

Our other cat lucky is a good girl and will eat whatever we put down so she's all pate as well.

The greater question is this....

How long do I let his sugars ride in the 300s? He's been back all pate for longer than a week now, almost 2.

Thanks for the additional information.

As I posted above, the change to dry food was most likely the reason for the high glucose readings with Ram Jam and hopefully by going back to the LC wet the need for insulin will be removed. If you do some spot testing as I suggested above now that he is not getting the dry and find that the levels are still too high, you could try a smaller dose..possibly 0.50 unit. There are syringes with 1/2 unit markings that make it easy to measure this. If you only have the syringe with 1 unit markings then you would have to eye-ball the dose.

If Booger is being very resistant to eating wet food, you could try a mix of wet with crumpled dry on top to encourage him to try and eat the wet. I changed to all wet food over 10 years ago and had a heck of a time with my girlie kitty, who also could not afford to lose weight. With different tricks, such as the dry food "topping", tuna juice on the wet, etc I finally got her to an all wet diet. Given the option, even now, she would choose dry over wet, but she will eat the wet without problem.

There are some lower carb dry food such as Young Again Zero and Evo Cat and Kitten ( I believe) and Wellness Core. The one that most people with dry food addicts have had the most success seems to be the Young Ago zero. It is very expensive and has to be ordered online, but it is suitable for diabetic kitties as well so if Ram Jam got into it, it shouldn't cause spikes in the glucose levels.

 

[Tuxedo Mom]

When Ram Jam went to the vet was there a full blood work and urinalysis done. If there is any sort of infection or dental issues, that can push a kitty out of remission. Of course if there is an infection or dental issues, then that will need to be dealt with and some insulin given while monitoring once the infection/issue is being dealt with. If there is no infection and the numbers are still running too high a week after the return to LC wet food then he may need some insulin for a period of time to keep the numbers from remaining high.

It is hard to know whether the 0.50 unit or 1.00 unit is the best approach. With your 12 hour shifts you will not be able to get mid cycle tests so you will not be sure just how low he is going during the cycle. Do you have some full days where you can do some more extended monitoring?

 

[Sarah Lee]

Yes he has no signs of infection. He has a nodule on his eyelid they want to remove and biopsy. That was the reason for the chemistry panel and blood count. Everything else looked great on his labs.

I work 3 -12s a week so I def have days to monitor him I'm just afraid of the insulin. I'll see if I can get a hold of some .5 unit syringes and consider trying that.

When Ram Jam went to the vet was there a full blood work and urinalysis done. If there is any sort of infection or dental issues, that can push a kitty out of remission. Of course if there is an infection or dental issues, then that will need to be dealt with and some insulin given while monitoring once the infection/issue is being dealt with. If there is no infection and the numbers are still running too high a week after the return to LC wet food then he may need some insulin for a period of time to keep the numbers from remaining high.

It is hard to know whether the 0.50 unit or 1.00 unit is the best approach. With your 12 hour shifts you will not be able to get mid cycle tests so you will not be sure just how low he is going during the cycle. Do you have some full days where you can do some more extended monitoring?

 

[Tuxedo Mom]

Yes he has no signs of infection. He has a nodule on his eyelid they want to remove and biopsy. That was the reason for the chemistry panel and blood count. Everything else looked great on his labs.

I work 3 -12s a week so I def have days to monitor him I'm just afraid of the insulin. I'll see if I can get a hold of some .5 unit syringes and consider trying that.

Again...difficult to know what to suggest. If you have a full day very soon, that may be the best time to do the 0.50 unit so that you can monitor the levels through the day. I hate to say don't give any insulin with the higher numbers, but since her is "new" to insulin after so long and there is a question as to whether the food caused the relapse, it is IMO more prudent to be able to get some good data when starting insulin again. My thoughts only...others may have a different opinion.

ETA If you do hold off on insulin for a day or so until you have a day off try to get some tests in as best as possible to track the numbers.

 

[Sarah Lee]

Again...difficult to know what to suggest. If you have a full day very soon, that may be the best time to do the 0.50 unit so that you can monitor the levels through the day. I hate to say don't give any insulin with the higher numbers, but since her is "new" to insulin after so long and there is a question as to whether the food caused the relapse, it is IMO more prudent to be able to get some good data when starting insulin again. My thoughts only...others may have a different opinion.

ETA If you do hold off on insulin for a day or so until you have a day off try to get some tests in as best as possible to track the numbers.

Thanks again for your input. I really appreciate it!

 

[Tricia Cinco(GA) & Harvey]

I'll see if I can get a hold of some .5 unit syringes and consider trying that.

If you have a Walmart near you, they carry syringes with 1/2 unit markings. Here's what you want:

Sarah, it will really help us to help you if you can put all the BG readings you have since Ram fell out of remission into a spreadsheet. Here are the instructions for setting it up. If you need help, just ask. We have several people that are wizzes with it.

Given your experience so far, I think I would wait to restart insulin until a day you can monitor.

Regarding getting your kibble addict to eat wet food, check out Dr. Lisa's site. She has some great tips for transitioning.

We're glad you found us!

 

[Girlie's mom]

I just wanted to second Tricia's warm welcome! It must be so frustrating to drop out of remission like that.

You've got some really experienced people here helping you, so you're in good hands!

 

[Sarah Lee]

Thanks everyone. I really Appreciate all of your advice. I'll work on the spread sheet later. So far today I went and picked up the 1/2unit syringes and gave rams 1/2 unit Lantus with a blood glucose of 311 at 2pm Fed him his wet food with a little tuna and I'll recheck his sugar around 6pm. Thanks!

 

[Tricia Cinco(GA) & Harvey]

Thanks everyone. I really Appreciate all of your advice. I'll work on the spread sheet later. So far today I went and picked up the 1/2unit syringes and gave rams 1/2 unit Lantus with a blood glucose of 311 at 2pm Fed him his wet food with a little tuna and I'll recheck his sugar around 6pm. Thanks!

If you need help with the spreadsheet, let us know.

Sarah, could you start a new thread when you check back in ? We ask members to try to do a new "condo" every day (or every day that they post) because sticking with the same one too long gets it really lengthy and hard to follow. When you start the new one, add a link to this one so that people can go back if they want to see what's already been said. Just ask if you don't know how to do it.

Here is a post we did to help new members get comfortable using the Board. Remember, ask lots of questions!! We love to help.