Question about assessing response to insulin/monitoring for hypoglycemia with a sleepy cat

kxk34

kxk34

Member
Hello! Today is my first day giving my cat Fuzzy insulin and I just had a question about how to monitor her for signs of hypoglycemia effectively.

We just gave her the injection (1 unit) at 8:03 am ET after she ate a meal. She was already looking very sleepy after eating (which is normal for her) and as soon as we finished giving her the shot she curled up on my lap and fell fast asleep. She tends to nod off when she’s very sleepy so she’s been doing that and she twitches a bit sometime (both normal). However, right now I’m very on edge about missing signs of hypoglycemia as soon as they appear so her normal sleeping behaviors are making me a bit nervous because I’m not sure how to assess how she’s doing while she’s resting like this.

We were planning to check her glucose levels in 1 hour to make sure everything is going smoothly. Is there any risk that hypoglycemia could set in before 1 hour? Is it fine if I let her sleep as usual in the meantime?
 
Jo B said:
What was her bg preshot? Also, which insulin?
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ProZinc insulin. Pre-shot BG was 377.

I don’t think anything is wrong or anything right now I just didn’t know if there was a time that was too soon after injection for it to be a concern or if I should be on alert for anything immediately and also realized bc she’s so sleepy normally it might not be obvious so just wanted to ask to get some clarification on that to be safe
 
Was the preshot fasting?

You won't notice any signs of hypoglycemia - if you do, it's usually things like seizures, walking in circles, stumbling, unresponsiveness, etc - it's straight to the ER.

Since it's your first day - start with +1.5 and go from there. There is usually a food bump at +1, sometimes lasts til +2 (depends when onset is for Fuzzy).
 
FrostD said:
Was the preshot fasting?

You won't notice any signs of hypoglycemia - if you do, it's usually things like seizures, walking in circles, stumbling, unresponsiveness, etc - it's straight to the ER.

Since it's your first day - start with +1.5 and go from there. There is usually a food bump at +1, sometimes lasts til +2 (depends when onset is for Fuzzy).
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I think so (if this amount of time counts)… She ate some food a little before 2 AM ET and we picked up the food after that so she wasn’t eating anything else too close to the pre-shot BG check. We checked her levels at 6:30 AM ET and then gave her food and let her eat for a while before giving her the shot.

Sounds good, thank you!
 
At 11:35 ET (a little over +3.5) Fuzzy’s BG was 218. I know it isn’t expected to reach the lowest point until around +6 hours, but are there times before then that we should check to make sure she isn’t getting too low? I’m just nervous about not realizing if something is wrong since she’s so sleepy today.
 
That's quite a drop. Still safe numbers but try to get her to eat a little bit

Now here's the problem - big and/or fast drops like that cause their liver to panic and dump stored glycogen into the body, so her BG will likely shoot right back up later today once insulin starts to wear off.

Let's see what nadir is, it can be anywhere from +4 to +8 with ProZinc
 
And here's the other problem - see how far that dose dropped her? It's not a directly linear relationship all the time, BUT see what would have happened if you gave it to her if she was below 300?

You really need a dose you can give when 200 or above. These 300s and 400s regularly will not be good for her long term. Over the next few days we'll be able to tell if this dose is just going to keep causing bouncing, or if she's just high numbers...and those are each handled slightly differently with ProZinc

I don't mean to beat a dead horse, just trying to explain.

I know you are uncomfortable going against vet's advice, that's the case with a lot of new people here. I suspect you'll follow it until you get frustrated that it isn't working, also the case with a lot of new people here lol Testing BG is how you will keep her safe while you figure out what's right for you guys
 
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FrostD said:
And here's the other problem - see how far that dose dropped her? It's not a directly linear relationship all the time, BUT see what would have happened if you gave it to her if she was below 300?

You really need a dose you can give when 200 or above. These 300s and 400s regularly will not be good for her long term. Over the next few days we'll be able to tell if this dose is just going to keep causing bouncing, or if she's just high numbers...and those are each handled slightly differently with ProZinc

I don't mean to beat a dead horse, just trying to explain.

I know you are uncomfortable going against vet's advice, that's the case with a lot of new people here. I suspect you'll follow it until you get frustrated that it isn't working, also the case with a lot of new people here lol Testing BG is how you will keep her safe while you figure out what's right for you guys
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I appreciate it. I honestly just wasn’t sure about whether she had a rationale for it because the whole once daily instead of twice thing really threw me off since (as you said) the ProZinc is not dosed that way for cats. And her resistance to changing the plan after we made it clear we weren’t comfortable starting at 1 unit also made me hesitant. But if it seems like this is causing Fuzzy discomfort or putting her at immediate risk then we can update accordingly. I asked today when we should move her to two doses and she said to continue with one dose through the weekend while Fuzzy adjusts to receiving insulin for the first time… but this is confusing because I don’t see how she can adjust if her numbers bounce all around like it seems may be the case and I still don’t get why she’d only dose once a day.

We checked her BG a few minutes ago because we were coming up on +6 hours and it was back up to 449 (I’m guessing because she’d just eaten some food not too long ago). She’s laying down now. Should I still be concerned about her levels dropping back down and potentially reaching a level that is too low?
 
I might be getting cats confused, but did she go to the vet today? Stress could have easily raised her BG.

As for one shot vs two...your call. I see no point doing this through the weekend when her numbers are obviously high, she's so underweight, not feeling good, etc. But just because you gave the 1U today and it was ok does not mean it will be the same every day, doubly so with the IBD and such. So you'll want to keep an eye on her for at least the next 3 days or so

I would leave her be. A check at +8 or 9 would be nice data to have, but not critical.

What's your current feeding schedule? Do you have an autofeeder? Multiple cats?

What's current medication schedule? What meds at what times (in the + format)

You have the "fun" of a complicated set of conditions. So what we need to do is work out the best timing for everything that doesn't throw BG out of whack. Example: knowing when the pred affects her BG will help you know when to give either the pred or the shot to help keep her curve nice and steady. And same with food - want to balance the effects of that, with the pred, with the shot. It sounds daunting, but shouldnt be too bad.
 
FrostD said:
I might be getting cats confused, but did she go to the vet today? Stress could have easily raised her BG.

As for one shot vs two...your call. I see no point doing this through the weekend when her numbers are obviously high, she's so underweight, not feeling good, etc. But just because you gave the 1U today and it was ok does not mean it will be the same every day, doubly so with the IBD and such. So you'll want to keep an eye on her for at least the next 3 days or so

I would leave her be. A check at +8 or 9 would be nice data to have, but not critical.

What's your current feeding schedule? Do you have an autofeeder? Multiple cats?

What's current medication schedule? What meds at what times (in the + format)

You have the "fun" of a complicated set of conditions. So what we need to do is work out the best timing for everything that doesn't throw BG out of whack. Example: knowing when the pred affects her BG will help you know when to give either the pred or the shot to help keep her curve nice and steady. And same with food - want to balance the effects of that, with the pred, with the shot. It sounds daunting, but shouldnt be too bad.
Click to expand...

She did go to the vet earlier today for her vitamin b injection. That was actually when her BG was lowest at 218. My guess is that it was lower there than it's been at home because it was a little more than an hour after we expected the insulin to kick in (+3.5 hours) and because we had to wait a while in the car before she could be seen because things were running behind schedule there so she hadn't eaten for a bit and had a long time to calm down from the drive over while sitting in the car.

Because she's so underweight and had previously not had much of an appetite at all we've just been giving her wet food whenever she wants it leading up to this (because she doesn't eat anywhere close to the whole can in a single sitting), in addition to having free graze dry food. The vet said we should try to get some sort of routine going, but also shouldn't limit her food since we do need her to eat. So we restricted food last night after we saw her eat at 2 AM so that we could get a fasting pre-shot BG and then gave her part of a can of wet food this morning and put her bowls back down. She ate a little bit after her shot as well and she ate some when we got home from the vet too. I'm a little confused on how exactly we're supposed put her on a schedule with eating while also not restricting her because she only eats small amounts at a time before getting distracted and circles back frequently so taking the food away outside of set times would just result in her getting less food overall and at under 4lbs she really can't afford to lose anymore weight :\

She received her prednisolone at +5 (1 PM ET) and she will get her other meds (metronidazole and pepcid) at +15 (11 PM ET).
 
I understand. Yes, absolutely, priority is weight gain. I think best you can do is offer the bulk of her food in the early part of the cycle and just hope she eats it. If she doesn't, continue to offer anyway obviously, but just know it may make the numbers a little wonky and regulation a little more difficult to achieve.

Is her pred just once a day? What dose?
 
FrostD said:
I understand. Yes, absolutely, priority is weight gain. I think best you can do is offer the bulk of her food in the early part of the cycle and just hope she eats it. If she doesn't, continue to offer anyway obviously, but just know it may make the numbers a little wonky and regulation a little more difficult to achieve.

Is her pred just once a day? What dose?
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Sounds good thank you! She had previously been on 8mg of pred and that dose was divided so she was getting it 2x daily, but when we got the diabetes diagnosis we reduced the dose to 5mg so she gets it once daily now.
 
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