Cat hypo last night - should we reduce dose?

[nepsola]

Hi everyone,

My name is Emma, and my cat is called Morrissey. I've added his details to my signature - hopefully it's worked.

He was diagnosed 4 months ago. He's on Caninsulin 2 units 2x daily (7am + 7pm). LC wet food only.

We've been trying to home test (have an AlphaTrak meter), but it's extremely difficult. He's scared/bites/scratches, and his ears rarely bleed. The vet has not been able to get a curve from him either. We're desperate to get his readings done consistently ourselves.

He had a single BG test at the vet 5 days ago, taken at 6pm (1hr before PM dose). It came out at 4mmol / 72mg, which the vet said was very promising. Fructosamine test came back at 277mg. We were advised to carry on with 2 units but look for signs of low BG.

Last night, he seemed to have a hypo episode. This was around 10pm (3hrs after his PM dose). We immediately gave him food (our vet suggests we do this rather than use syrup, unless he's near-unresponsive?). We then managed to get a reading - 2.7mmol / 50mg (on AlphaTrak). We couldn't get another reading afterwards, but monitored him very closely, and he recovered well.

I skipped his dose this morning, because I couldn't get a pre-shot reading, and I wanted to talk to the vet before giving him any more insulin. They've advised us to keep giving him 2 units.

My question is -
- If I can't get a pre-shot reading, what would you recommend I do?
- If I can get a pre-shot reading, how should I interpret the result? i.e. When should I skip, or reduce, if at all?

Thank you so much to anyone who reads this. xx

 

[Bron and Sheba (GA)]

Hi Emma and Morrissey welcome to the forum. I am sorry no one answered you sooner.
2.7 (50) on the alphatrak meter is very low. If that happens again give honey or Karo as it will bring up the a BG much quicker than food. Then follow it with some food.
Yes you definitely need to reduce the dose. I am not a caninsulin user and will tag @Critter Mom to help you. She is in the UK so might not be on til later.
I have just seen that @JanetNJ is online so may be able to help with caninsulin.

I will give you some tips on how to hometest the BGs. Keep persevering as it is the only way to keep Morrissey safe. Are you offering a treat each time you test...successful or not. Try giving him a small low carb treat as you are testing to distract him.
https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

If you wait until Morrissey has hypo symptoms he will have dropped dangerously low. Home testing is the only way to safely monitor and give the insulin. If he had a BG of 4 1 hour before the next dose of caninsulin the vet should have reduced the dose then. Caninsulin is a fast acting insulin and it is not safe to give him a dose of the BG is around 4 (72).
Are you feeding him then waiting 1/2 hour before giving the shot?
Are you giving him snacks of food during the cycles as well as the preshot meal?

If you could set up a spreadsheet and start entering the blood glucose numbers we can help you
Here is a link to the SS instructions. If you have any trouble I can ask @Bandit's Mom to help you with it.
https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

Here is a link to how to manage a hypo.......make sure you always have high carb food and honey or Karo in the house
https://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

I would ask the vet to swap you over to a much more suitable insulin for cats such as Lantus or Prozinc. Caninsulin is an insulin which was made for dogs.
In the meantime I will send you the link for how to use caninsulin.
https://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/

keep asking questions. We can help you.
Bron

 

[JanetNJ]

Hi everyone,

My name is Emma, and my cat is called Morrissey. I've added his details to my signature - hopefully it's worked.

He was diagnosed 4 months ago. He's on Caninsulin 2 units 2x daily (7am + 7pm). LC wet food only.

We've been trying to home test (have an AlphaTrak meter), but it's extremely difficult. He's scared/bites/scratches, and his ears rarely bleed. The vet has not been able to get a curve from him either. We're desperate to get his readings done consistently ourselves.

He had a single BG test at the vet 5 days ago, taken at 6pm (1hr before PM dose). It came out at 4mmol / 72mg, which the vet said was very promising. Fructosamine test came back at 277mg. We were advised to carry on with 2 units but look for signs of low BG.

Last night, he seemed to have a hypo episode. This was around 10pm (3hrs after his PM dose). We immediately gave him food (our vet suggests we do this rather than use syrup, unless he's near-unresponsive?). We then managed to get a reading - 2.7mmol / 50mg (on AlphaTrak). We couldn't get another reading afterwards, but monitored him very closely, and he recovered well.

I skipped his dose this morning, because I couldn't get a pre-shot reading, and I wanted to talk to the vet before giving him any more insulin. They've advised us to keep giving him 2 units.

My question is -
- If I can't get a pre-shot reading, what would you recommend I do?
- If I can get a pre-shot reading, how should I interpret the result? i.e. When should I skip, or reduce, if at all?

Thank you so much to anyone who reads this. xx

That's very low for alpha track. You need it over 68. I would reduce to no more than 1.5... Keep practicing the testing. It's super important esp since it seems his insulin needs are decreasing.

We advise new people to not shoot under 200

 

[Christie & Maverick]

Hi Emma, I am concerned about the fructosamine reading of 277. That may indicate prolonged hypoglycaemia.

https://www.merck-animal-health-usa.com/vetsulin/cats/glycated-protein-levels

While I am not familiar with your insulin, I would be very cautious giving insulin without a test. I wish I could say ask your vet but The fact that they said keep to 2u is quite disturbing. That, plus any symptomatic hypo will make the cat more sensitive to insulin.

 

[JanetNJ]

If you could set up a spreadsheet in your signature that would be super helpful to us to give you specific dosing advice.

 

[Bandit's Mom]

If you need any help with setting up the spreadsheet please let me know. I can do it for you.

 

[nepsola]

Hi Emma and Morrissey welcome to the forum. I am sorry no one answered you sooner.

Hi Bron, that's totally ok. Thank you so much for your response, and the links. This is exactly my concern. If his BG was 4 at 6pm (an hour before shot), I now don't know why the vet didn't suggest we adjust the dose immediately or skip. Or why they have told us to continue with 2 units after a hypo episode. We dropped to 1.5u last night as 2u didn't seem right to us (then saw your reply just now).

We give him his insulin during the last few mouthfuls of his meal. It takes him about 30 minutes to eat, as we have to give him food slowly otherwise he eats too quickly and throws it back up (something he's done since he was a kitten).

We're giving him snacks during the cycles, yes. Meals at 7am + 7pm with AM/PM dose, then snacks at 5am, 10am (3hrs after shot), 10pm (3hrs after shot). We're going to really persist on getting blood from him. We tried again this morning and still couldn't get his ears to bleed.

We haven't been giving him treats while trying to take blood as we were concerned this would spike the reading? But if that's something we can do, that would be brilliant. Does anyone here use a lancet pen that works? I'm wondering if that will be simpler than trying to freehand the lancet.

I'll definitely set up the spreadsheet once I have some figures to put into it. We're trying again to build a curve this week, although we understand it might be a bit skewed for the next few days since he had a hypo episode. Our goal is to at the very least know exactly what his BG is before we give him any insulin, and then to test again 2 + 4 hrs afterwards to see how low he's dropping.

I think we're going to call and ask to speak to a different vet, because as you say, this doesn't seem right.

 

[nepsola]

Thank you also Christie, Janet and Bhooma. I'll update as soon as I can get any more readings from him. I'm really worried right now.

 

[Bron and Sheba (GA)]

Make sure the treats you give him are low carb treats. Even bits of cooked chicken or similar.
I also have a cat who likes to bolt down his food and will then vomit.
I feed him on a large plate which slows him down and give smaller more frequent meals.
I used a lancet device to get the blood and liked it. Others like to do it freehand.
Are you warming the ear before you try and are you putting a ball of cotton wool behind the eat to brace it as you prick it?
You can also “milk” the ear beforehand to get the blood in the ear.

 

[JanetNJ]

We haven't been giving him treats while trying to take blood as we were concerned this would spike the reading?

Snacks during testing is fine. It takes about 10-15 min for the food to hit the bloodstream. What size lancet are you using? Are you warming or rubbing the ears before you poke? Are you aiming for the sweet spot?


If you are worried then rather than 1.5, drop that dose down to 1 unit until testing is easier. The more you attempt tests the easier it will be because the capillaries will start to grow in. I have a video in my signature showing how I test my cat CC at home.

 

[Critter Mom]

Hi Emma.

I agree with the others above that the dose needed to be reduced.

trying to freehand the lancet.

Here is the testing method I used. Perhaps it might give you some ideas to add to your own testing technique.

1. For most meters you can insert a test strip part way without switching it on. Once you've done the poke you can then push the strip the rest of the way into the meter to activate it. (Reduces the likelihood that the meter will time out before you can get the blood sample onto the strip.)
   
   
2. Fold a sheet of kitchen paper in four lengthwise and cut it up into 1" strips. You will use these to cushion and support the ear during the test.
   
   
3. Apply a thin film of Vaseline or Neosporin ointment (not the cream!) onto the edge of the ear to help the blood sample bead up instead of wicking into the fur. (Wipe off any excess.)
   
   
4. To get a blood sample you need to increase the blood flow to the ear, so make sure the ear is really, really, really warm (but not hot) - especially in the early days of testing. (Note: With repeated 'poking', more capillaries form in the test area, so it becomes easier to get samples reliably.)
   
   
5. Once you have the testing area of the ear well warmed, wrap a strip of folded kitchen paper round your index finger then place finger under the sweet spot area of the ear you're testing to support it during the poke.
   
   
6. Use your thumb and middle finger to lightly but firmly grip the ear and paper strip in place so that the edge of the ear is taut but not overstretched; the little bit of tension will make it easier for the lancet to break the skin surface (and it helps to keep kitty's head from moving around too much).
   
   
7. When using a lancet 'freehand', make sure the bevelled side of the lancet is facing upwards. Hold the lancet at a slight angle to the ear similar to the way you hold a pen when writing, not perpendicular (easier to see where you're aiming and also makes skin prick easier).
   
   
8. When it comes to the actual poke, prick the sweet spot on the edge of the ear in a similar way to how you might quickly prick a balloon with the tip of a needle to make it pop. If you aim as close to the edge of the ear as possible you are less likely to hit the marginal ear vein.
   
   
9. Keep hold of the ear while you're pushing the test strip into the meter to activate it. (Kitties are prone to shake their heads after a poke, sending your precious blood sample flying across the room. Holding the ear reduces likelihood of this happening.)
   
   Note: As you become more practised in testing, you'll be able to activate the meter just before doing the poke and still have plenty of time to collect the sample on the strip before it times out.
   
   
10. When using the glucometer, bring the test strip to where it j-u-s-t comes into contact with the blood droplet and hold it there. The strip should then 'sip up' the amount it needs to run a valid test. Most meters beep or give a visual cue to let you know that enough blood has been collected on the strip.
    
    If your cat is a wriggler, try collecting the blood sample on the back of your (clean) fingernail and test it from there.
    
    If a test fails and you still have a lot of blood on the strip from the failed test, don't throw it away. Instead, you could pop another strip into the meter and test using the blood on the strip from the first test. (Saves an additional poke so also helpful for wriggly kitties!)
    
    
11. After the test, fold the paper strip over the edge of the ear and apply gentle pressure to the test area for about 20-30 seconds to minimise bruising.
    
    
12. Keep giving lots of praise throughout the process and reward with a favourite diabetic-friendly treat or favourite activity (e.g. brushing).

With a bit of time and practice you'll be able to work out a technique and a routine that works best for you and Morrissey.

See member Farmkitty's excellent pictorial tutorial for visuals of some of the techniques described above:

https://www.felinediabetes.com/FDMB/threads/hello-food-and-insulin-questions.240117/#post-2709047

In particular, have a look at the pictures of the backlit ear before and after adequate warming. The difference in blood flow is really striking!


Mogs
.

 

[nepsola]

Are you warming the ear before you try and are you putting a ball of cotton wool behind the eat to brace it as you prick it?
You can also “milk” the ear beforehand to get the blood in the ear.

Yes, we're warming the ear first and massaging it. We've tried warm rice sock, warm dry cloth, bottle, etc. Sometimes the problem is that it's hard to get to his ears at all, as he hates them being touched. So to get him to be still long enough to massage/warm them can be difficult. The only time he'll actually let us get even close to his ears without a huge struggle is when he's hypo. When we can manage to get to his ears despite the struggle, we're rarely able to get blood, even with multiple pricks.

 

[nepsola]

Snacks during testing is fine. It takes about 10-15 min for the food to hit the bloodstream. What size lancet are you using? Are you warming or rubbing the ears before you poke? Are you aiming for the sweet spot?

If you are worried then rather than 1.5, drop that dose down to 1 unit until testing is easier. The more you attempt tests the easier it will be because the capillaries will start to grow in. I have a video in my signature showing how I test my cat CC at home.

Thank you Janet Yes, we're warming/massaging the ears before poking and aiming for the sweet spot. The only time I've been able to get blood is by accidentally hitting the vein. We've been trying for about 2 months every day. We really hoped his ears would be easy to get blood from by now.

We're using a 28 gauge lancet. We've been giving him chicken during testing now since seeing your reply (before we were only giving it right after testing).

 

[nepsola]

Hi Emma.

I agree with the others above that the dose needed to be reduced.

.

Thanks so much for the reply Mogs. We've been doing what you suggested but so far, we just are so rarely getting blood. Perhaps we are not warming his ear enough. It's a real struggle because he hates having his ears touched and will hiss/bite/scratch whenever we get near them, so massaging/warming them is difficult. We had been trying to take a gentle approach because we figured he'd be better off in the long-run if we could make it as least-traumatic as possible for him. But it seems like his numbers have dropped so soon that it's now a case of urgency, and we feel stuck.

I totally agree about his dose. We took him to the vet yesterday and they've advised 1 unit and monitoring his behaviour if we can't get a reading. The vet has said they will call us every day for the rest of the week to follow up.

 

[nepsola]

I've uploaded the spreadsheet. Unfortunately there's not much to go on. Some readings were taken at the vet (in italics).

He had another hypo episode yesterday morning, after reducing to 1.5u. We caught it quickly and he recovered well, then we took him into the vet to try to get a curve, and to make sure he could be monitored. They managed to get a few readings, but had to return him early as he was too stressed and shut down. We skipped his dose for PM once he came home, as we didn't want to risk it. I've entered the readings on the spreadsheet.

They recommended we reduce to 1 unit and monitor his behaviour if we can't get a reading. So we gave 1 unit this morning. He seemed lethargic two hours later, so I gave him food and some syrup as a precaution, because again, we couldn't get any blood. My feeling is that he probably needs to reduce to 0.5 units, if any at all, but I don't want to send his BG all over the place.

What I want to be able to do is test him before giving him any insulin at all, at this point. But I'm totally at a loss. Thank you everyone for all your help.

 

[JanetNJ]

Thank you Janet Yes, we're warming/massaging the ears before poking and aiming for the sweet spot. The only time I've been able to get blood is by accidentally hitting the vein. We've been trying for about 2 months every day. We really hoped his ears would be easy to get blood from by now.

We're using a 28 gauge lancet. We've been giving him chicken during testing now since seeing your reply (before we were only giving it right after testing).

Ok I have to ask since you are using an alpha and I made this mistake in the beginning. You are DIPPING the little protruding bump that is on the edge of the black into the drop, not trying to scoop a drop onto the black spot, correct?

 

[JanetNJ]

 

[Critter Mom]

Test areas on Alphatrak strip with the little protrusions Janet refers to above:

Mogs
.

 

[Critter Mom]

@JanetNJ - Snap!

.

 

[nepsola]

Ok I have to ask since you are using an alpha and I made this mistake in the beginning. You are DIPPING the little protruding bump that is on the edge of the black into the drop, not trying to scoop a drop onto the black spot, correct?

Yes love, just dipping / touching it to the blood (not scooping)

 

[nepsola]

Another quick update - just had the call from vet
They got his latest fructosamine result back (from test taken yesterday) and it was 277. Exactly the same result he got on the 20th Jan (one week ago).
The vet thinks he's in remission.
We've decided it would be better to take him off the insulin for now rather than risk another hypo.

So now we need to figure this BG issue out so that we can monitor him closely. I pretty much expect him to need to go back on it sooner or later, so I want to become a pro at this like you guys! I feel so completely inept. Today I managed to see the tiniest shiny prick of blood on his ear, but no matter how much I massaged, used heat, etc., it wouldn't swell into a nice drop I could test.

 

[JanetNJ]

Another quick update - just had the call from vet
They got his latest fructosamine result back (from test taken yesterday) and it was 277. Exactly the same result he got on the 20th Jan (one week ago).
The vet thinks he's in remission.
We've decided it would be better to take him off the insulin for now rather than risk another hypo.

So now we need to figure this BG issue out so that we can monitor him closely. I pretty much expect him to need to go back on it sooner or later, so I want to become a pro at this like you guys! I feel so completely inept. Today I managed to see the tiniest shiny prick of blood on his ear, but no matter how much I massaged, used heat, etc., it wouldn't swell into a nice drop I could test.

If you must, hit the vein.

 

[nepsola]

If you must, hit the vein.

That's what I've been thinking. Trying to aim for it. I might have to shave his ear (he has black fur). Blood can't be taken from anywhere else can it? Except for the paw?

 

[JanetNJ]

Ea

That's what I've been thinking. Trying to aim for it. I might have to shave his ear (he has black fur). Blood can't be taken from anywhere else can it? Except for the paw?

Ear and paw. Poke with determination. Don't be afraid to poke all the way through.

 

[Critter Mom]

Hi Emma,

Yes, we're warming the ear first and massaging it. We've tried warm rice sock, warm dry cloth, bottle, etc. Sometimes the problem is that it's hard to get to his ears at all, as he hates them being touched.

Does Morrissey just not like the ears being touched per se, or does he object more to something in the ear? I ask because Saoirse absolutely despised anything going even a little way into in her ear so rice socks were a big fail for us. So were warm washcloths (the technique our vet taught).

I thought I'd try to find a means of warming the sweet spot area that wasn't bulky (or wet). I landed on using a plastic pipette filled with finger-hot water (to compensate for the thermal resistance of the plastic). Here's a pic:

Worked like a charm! I could hold the length of the bulb along the edge of Saoirse's ear without her getting irritated. That made it much easier to warm the ear long enough to encourage adequate blood flow. I used to stand the pipette in a cup of hot water till I was ready to use it so that it wouldn't lose heat while I was preparing Saoirse's ear for testing. When learning to test, I was quite taken aback at just how toasty-warm the ear needs to be to get a sample.


Mogs
.

 

[Critter Mom]

We've decided it would be better to take him off the insulin for now rather than risk another hypo

Smart. I'd even have been worried that a reduction to 0.5IU might not have been enough.

Because you're suspending insulin treatment and aren't 100% sure of Morrissey's status, as a general safety precaution it would be a good idea to check his pee daily to make sure he's ketone-free. More info:

Ketones, Diabetic Ketoacidosis and Ketone Meters

Tips for Collecting Urine Samples

Given that BG testing's tricky sometimes, it might be worth testing with Ketodiastix so that you can check for both ketones and glucose in the urine. Urine glucose testing is a crude way to monitor but it would at least give you an idea of whether Morrissey's BG levels are remaining under the renal threshold (c. 250-290mg/dL on pet-calibrated equipment according to online Merck Veterinary Manual, varies from cat to cat). Measuring daily water consumption might be helpful to you also. Some information is better than none. And snag what BG tests you can any time the circumstances look a bit more auspicious!


Mogs
.

 

[nepsola]

Hi Emma,


Does Morrissey just not like the ears being touched per se, or does he object more to something in the ear? I ask because Saoirse absolutely despised anything going even a little way into in her ear so rice socks were a big fail for us. So were warm washcloths (the technique our vet taught).

I thought I'd try to find a non-bulky means of warming the sweet spot area that wasn't bulky (or wet). I landed on using a plastic pipette filled with finger-hot water (to compensate for the thermal resistance of the plastic). Here's a pic:


View attachment 59555


Worked like a charm! I could hold the length of the bulb along the edge of Saoirse's ear without her getting irritated. That made it much easier to warm the ear long enough to encourage adequate blood flow. I used to stand the pipette in a cup of hot water till I was ready to use it so that it wouldn't lose heat while I was preparing Saoirse's ear for testing. When learning to test, I was quite taken aback at just how toasty-warm the ear needs to be when testing.


Mogs
.

This is AWESOME. I'm going to try this (how on earth did you even think of it?!). He hates having his ears touched generally, but definitely hates having something in the ear even more (cotton wool, cloths, etc). I think this is what I've been doing wrong - not getting his ear warm enough. Thank you so much.

 

[nepsola]

Smart. I'd even have been worried that a reduction to 0.5IU might not have been enough.

Because you're suspending insulin treatment and aren't 100% sure of Morrissey's status, as a general safety precaution it would be a good idea to check his pee daily to make sure he's ketone-free. More info:

Ketones, Diabetic Ketoacidosis and Ketone Meters

Tips for Collecting Urine Samples

Given that BG testing's tricky sometimes, it might be worth testing with Ketodiastix so that you can check for both ketones and glucose in the urine. Urine glucose testing is a crude way to monitor but it would at least give you an idea of whether Morrissey's BG levels are remaining under the renal threshold (c. 250-290mg/dL according to online Merck Veterinary Manual, varies from cat to cat). Measuring daily water consumption might be helpful to you also. Some information is better than none. And snag what BG tests you can any time the circumstances look a bit more auspicious!


Mogs
.

This is SO helpful. Ketones were going to be my next question. Exactly! Without consistent BG readings (yet!) I want to try to gain as much data as I can. I'm going to be measuring his water out too. We have another cat (Pixies) but even if they both drink from it, we'll be able to notice if there's a sudden increase in drinking overall between them. I'm going to read the ketone links right now <3