Recent hypoglycemic episode, skipped this morning shot cause he wouldn’t eat, right thing to do?

[tedsmom1]

Sunday Ted has his first hypoglycemic episode, he’s been diabetic since 2023 and his numbers always run high, he’s never had a crash like this. But a couple hours after his shot that morning he threw up and seemed a tiny bit wobbly, so I tested his sugars again. It was 37! I gave him some tuna to get him to eat something, then rushed him to the emergent vet. They had said let him eat what he’s willing and bring him in. (I know syrup or something like that is what is recommended, I was just freaking out and not thinking and I just knew he needed to eat to raise it that’s why I did tuna). Got it up to 60 by the time he got back there and tested again by them. They were able to get his sugars leveled out fairly easy, but they found his creatinine and bun levels in his kidneys were elevated. So he ended up staying over 48hrs getting fluids, and thankfully the numbers came back down to normal. His insulin dose changed to 1.5 from his original 2.5.

He did do well yesterday, he’s been eating and drinking and going to the bathroom well. But this morning he wasn’t wanting to eat anything I offered, he was drinking, but then he just hid under the bed. His number was 434, but since his episode I was terrified to still give him his shot if he wasn’t eating and I’d be at work not able to check his levels. I had to leave for work, I ended up being a bit late anyways. I’m here now and checked the camera and he’s still snoozing under the bed. Was it the right thing to do to skip? We have a regular vet appt tomorrow to recheck his kidney levels and make sure they stayed good. I’m just so worried and stressed. He’s my whole world.

 

[CORKY]

@Wendy&Neko

 

[Suzanne & Darcy]

Oh my. I am sorry this happened to your Ted. That is too low (37) as you know, and I am glad you caught it. Next time he is too low then please immediately give him honey or Karo syrup on his gums and also a small amount of High Carb food such as Fancy Feast Gravy Lovers wet food. Then retest his blood glucose in 20 minutes. Keep repeating this procedure until he is above 50 on a human glucometer (above 68 if using a pet meter). Once he is above 50 you can give small amounts of lower carb food. It’s very important to make the food amounts small in order to keep him hungry enough to take the snacks that you are using to manage the blood glucose. Keep monitoring for a full two hours after the last high carb food is given to make sure he does not drop back down. As he begins to rise you can start extending the time between tests.

 

[Suzanne & Darcy]

Without spreadsheet data, I can’t comment about the dose or the BG numbers. What I can say is that after a symptomatic hypoglycemic episode some cats can be more sensitive to insulin for a time. I think it’s wise that you have given him a dose reduction.

As for skipping the shot — since he recently had low BG and he wasn’t eating and you were not going to be at home…. I probably would have done the same thing.

I hope his kidney values are still normal and that he is just feeling crummy because pf the high BG. You can get that back down.

 

[Suzanne & Darcy]

What kind of insulin are you using?

 

[tedsmom1]

What kind of insulin are you using?

He is on ProZinc. I have an app I put his levels and doses in, but I’ll start a spreadsheet tonight. He’s been under my bed most of the day when I check the camera, so I know he’s not feeling well. I’ve just felt sick all day that I did wrong not giving him his shot, but it was so scary with his episode, I was just terrified it would drop when I was stuck at work. I tried to see about going home on lunch to check on him but couldn’t.

 

[CORKY]

Without spreadsheet data, I can’t comment about the dose or the BG numbers. What I can say is that after a symptomatic hypoglycemic episode some cats can be more sensitive to insulin for a time. I think it’s wise that you have given him a dose reduction.

As for skipping the shot — since he recently had low BG and he wasn’t eating and you were not going to be at home…. I probably would have done the same thing.

I hope his kidney values are still normal and that he is just feeling crummy because pf the high BG. You can get that back down.

Here's the link to create the Spreadsheet

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

 

[CORKY]

Is always good to follow your instincts 1 -2 hours prior to shot, if you are not comfortable with his BG post on the PROZINC FOURM with new thread and title it 911(in Red) and title “LOW BG PRIOR TO SHOT, it will be first hand noticed, and you can a quick answer! You’re doing a great job! Always know that cats are very sensitive to stress, you stress, they stress, so take a step back, breath in breath out!

 

[tedsmom1]

Is always good to follow your instincts 1 -2 hours prior to shot, if you are not comfortable with his BG post on the PROZINC FOURM with new thread and title it 911(in Red) and title “LOW BG PRIOR TO SHOT, it will be first hand noticed, and you can a quick answer! You’re doing a great job! Always know that cats are very sensitive to stress, you stress, they stress, so take a step back, breath in breath out!

Thank you for all your help! I appreciate it more than you know! I just got home and tested him and weirdly he’s a bit lower than this morning. He read 434 this morning but was 407 just now. Does look like he ate a tiny bit today. I offered fresh kibble and he ate some. I’ll do his 1.5 shot soon and then maybe test again in a couple hours?

 

[CORKY]

Kibbles are very high in carbs between 25-30% carbs to best stabilize the BG you should feed between 0-10% carbs most members feed Fancy Feast pate between 0-10% most of us feed up to 5%
You should create a HYPO KIT, this should include some medium carb foods between 11-15% carb soñé high carb food between 16-24% carbs some KARO or honey this in case the BG gets lower than 50, is always good to begin to raise the BGs by feeding a tsp of low carbs every 1/2 hour the protocol would be test feed 1/2 tsp of low carb repeat until safe numbers if BG continues low then you would feed medium carbs following the same routine, you want to keep the syrup honey and high carbs if is absolutely necessary, like I explained posts Ud and we can walk you to safe nimbers

 

[CORKY]

Thank you for all your help! I appreciate it more than you know! I just got home and tested him and weirdly he’s a bit lower than this morning. He read 434 this morning but was 407 just now. Does look like he ate a tiny bit today. I offered fresh kibble and he ate some. I’ll do his 1.5 shot soon and then maybe test again in a couple hours?

ProZinc kicks within 2 hours so is very important to test after the two hours in your spreadsheet that would +2, I’m an obsessive tester and Corky is tightly regulated, and I shoot on low two digest, I do not recommend you to do this, but you can review Corky’s SS and see how Ted’s would look like, you can also scroll the SS To the left and see under remarks how, when and what I feed him, if you are not home during the day a programmable wet food feeder is a good idea, this will keepTed’s BG In check during the day, here are some examples, some have cameras and chips

 

[tedsmom1]

Oh wow, I didn’t know that had cool feeders like that! Yes I’ll work on making a spreadsheet with what I have. I did just test him two hours after his shot and it’s dropped quite a bit, 182 from the original 407. But you’re saying two hours after usually is a big dip?

 

[Suzanne & Darcy]

Oh wow, I didn’t know that had cool feeders like that! Yes I’ll work on making a spreadsheet with what I have. I did just test him two hours after his shot and it’s dropped quite a bit, 182 from the original 407. But you’re saying two hours after usually is a big dip?

No. It doesn’t mean a big dip.
ProZinc typically onsets at about +2 and you will start to see the BG go down. That can be a little sooner for some cats (around +1.5). I always encourage ProZinc users to give a small snack at around +2 and to grab a BG test if they can. Then another small LC wet food snack a bit later in the cycle at around +4 is good. These small snacks/little meals can help prevent steep drops in BG and will help to smooth the cycle overall. That’s why a lot of people use the automated feeders.

How is your baby doing today?

 

[Suzanne & Darcy]

T

just got home and tested him and weirdly he’s a bit lower than this morning

This is most likely from lack of food that his BG went down.

 

[Suzanne & Darcy]

Will you be at home this weekend to watch over him?

What is his usual diet and feeding schedule?

 

[tedsmom1]

Will you be at home this weekend to watch over him?

What is his usual diet and feeding schedule?

Yeah I’m staying home this weekend with him, keeping a close eye on him. Altho I think he’s getting tired of me being in his business so much, ha. I started a spreadsheet, I uploaded it with what I have from this week. I need to add this mornings. We saw his regular vet yesterday for bloodwork follow up about his kidneys, but they said may take a couple days to get back. I’m praying his kidney levels are still good. Making sure he is eating enough is my biggest challenge right now. He was already the world’s pickiest eater, but with diabetes it’s dangerous. I’ve bought every kind/brand of wet food you can imagine, he rejects it all. I found a list on this forum about a year ago of the best dry foods if they won’t eat wet, had to buy almost every brand and flavor before he decided he’d eat the Epigen 90. And sometimes I can get him to eat tuna if I’m desperate to get him to eat anything. But even that he rejects sometimes! I love him but boy does he stress me out I’ve been checking his levels before I feed him, like around 5ish, then shot time is 530. I really appreciate you responding to me and talking to me. It feels so lonely doing this, I’m scared I’m going to do the wrong thing. I just want to do my best for him.

 

[Suzanne & Darcy]

Yeah I’m staying home this weekend with him, keeping a close eye on him. Altho I think he’s getting tired of me being in his business so much, ha. I started a spreadsheet, I uploaded it with what I have from this week. I need to add this mornings. We saw his regular vet yesterday for bloodwork follow up about his kidneys, but they said may take a couple days to get back. I’m praying his kidney levels are still good. Making sure he is eating enough is my biggest challenge right now. He was already the world’s pickiest eater, but with diabetes it’s dangerous. I’ve bought every kind/brand of wet food you can imagine, he rejects it all. I found a list on this forum about a year ago of the best dry foods if they won’t eat wet, had to buy almost every brand and flavor before he decided he’d eat the Epigen 90. And sometimes I can get him to eat tuna if I’m desperate to get him to eat anything. But even that he rejects sometimes! I love him but boy does he stress me out I’ve been checking his levels before I feed him, like around 5ish, then shot time is 530. I really appreciate you responding to me and talking to me. It feels so lonely doing this, I’m scared I’m going to do the wrong thing. I just want to do my best for him.

He won’t eat Dr. Elsey’s kibble? Not any of the flavors? Or Young Again?

 

[Suzanne & Darcy]

Try to get few tests today so we can see what he is doing on the 1.5 dose.

 

[Suzanne & Darcy]

Yeah I’m staying home this weekend with him, keeping a close eye on him. Altho I think he’s getting tired of me being in his business so much, ha. I started a spreadsheet, I uploaded it with what I have from this week. I need to add this mornings. We saw his regular vet yesterday for bloodwork follow up about his kidneys, but they said may take a couple days to get back. I’m praying his kidney levels are still good. Making sure he is eating enough is my biggest challenge right now. He was already the world’s pickiest eater, but with diabetes it’s dangerous. I’ve bought every kind/brand of wet food you can imagine, he rejects it all. I found a list on this forum about a year ago of the best dry foods if they won’t eat wet, had to buy almost every brand and flavor before he decided he’d eat the Epigen 90. And sometimes I can get him to eat tuna if I’m desperate to get him to eat anything. But even that he rejects sometimes! I love him but boy does he stress me out I’ve been checking his levels before I feed him, like around 5ish, then shot time is 530. I really appreciate you responding to me and talking to me. It feels so lonely doing this, I’m scared I’m going to do the wrong thing. I just want to do my best for him.

It can be super stressful! Especially after what happened with his low number last week.

 

[tedsmom1]

He won’t eat Dr. Elsey’s kibble? Not any of the flavors? Or Young Again?

Nope. I tried every flavor of dr elseys. And did get young again as well. He looked offended by all of it. It felt like a miracle he agreed to the Epigen 90. He was on the hills science that the vet originally prescribed, but I wanted to find something better since he refuses wet food. He did eat more tuna since his shot. But I’ll grab another reading here and see what he’s at.

 

[Suzanne & Darcy]

Not too bad for a +4 but did you get a +6? I am hoping he went down more?

 

[Suzanne & Darcy]

So does he just free feed on kibble all day long then?

 

[tedsmom1]

So does he just free feed on kibble all day long then?

I didn’t get another reading, I was trying to give him some space to relax. The vet called and got the bloodwork back, she didn’t say which but one of his kidneys levels was a bit elevated, but the other wasn’t. That he may be still a bit dehydrated. But she did say the SDMA levels were elevated, which indicates the start or possible start of kidney disease. She wants to check again in a month. Since he just went through a lot she said to let him settle in and relax a couple weeks then check, because he just went through a very stressful experience. Since he has mild heart disease too, this could make things really hard. He has his follow up cardiologist visit in August, so I’ll see how that’s looking then. He saw them last year, and the cardiologist said it was mild enough to not need meds yet, but wanted to see him in a year to see how he is. I’m just a wreck, I know all of it together is not good. She said what each thing needs to be treated can also be counterproductive to the other, so it’s a balance. She also was going to follow up on the Libre the other vet called in, they want me to try them again.

 

[Suzanne & Darcy]

How is Ted?

 

[tedsmom1]

How is Ted?

Thank you for asking! That week he came home from the emergent vet stay, we went to his regular vet to get bloodwork follow up. She said his BUN level was raised again, but that could be for a few reasons. She said he may be heading towards kidney disease or is in the start of it, and wants a bloodwork follow up in a month to see. We are going to the vet today to get a Libre put on. Which is good because he threw up this morning and again just now. His glucose was 522 when I tested this morning the first time he threw up. Highest it’s been in a long time! He’s acting like he wants to eat but isn’t. I’m hoping it’s just nausea and not anything worse. He’s acting fine otherwise. He’s up and moving fine and chatty like normal. He’s just acting like he’s hungry but can’t eat. Our appt isn’t until 4 today tho. But hopefully they can check him out and make sure he’s okay. I’m wondering if they can give me anything for when his tummy gets upset.

 

[Suzanne & Darcy]

I’m sorry to hear this. That BG is much too high as you know. Are you testing him for ketones? Ketones can build up very quickly and, in some cats (like mine) even when they are in the 200s. You want to prevent a DKA.

Cerenia is very effective for controlling vomiting and helping to some extent with nausea. You can get a shot for it at the vet that would be effective for 24 hours. It can be given at home in pill form as well (and is best purchased from somewhere else other than the vet because it’s expensive and places like Chewy or Allivet have better prices.)

Anyway, I would ask them to check his ketones if you are not testing at home. Hopefully, he isn’t a cat who is ketone prone.

What is his current ProZinc dose? Have you increased it?

Good luck with the Libre sensor. Do you have a little shirt to put over it?

 

[squeem3]

Nausea can be treated with odansetron. Most vets will prescribe the pills but it is available as an injectable which your vet may have or you buy from Chewy with a prescription. The pills can be bought at any Human pharmacy with a prescription. The brand name is Zofran which people take.

Pancreatitis is very common in diabetic cats. Treatment is some combo of anti nausea, anti vomiting, appetite stimulant, and pain med. The vet can do a FPLI blood test to diagnose.

There's info on using the Libre here: Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats

A Libre is more expensive than a manual meter and is known to fall off or malfunction before the 2 week change date. If your cat will let you test from the ear or paw pad, that would be ideal and cheaper. Even if you use a Libre, you need to know how to manually test if the Libre isn't working or falls off.

 

[tedsmom1]

I’m sorry to hear this. That BG is much too high as you know. Are you testing him for ketones? Ketones can build up very quickly and, in some cats (like mine) even when they are in the 200s. You want to prevent a DKA.

Cerenia is very effective for controlling vomiting and helping to some extent with nausea. You can get a shot for it at the vet that would be effective for 24 hours. It can be given at home in pill form as well (and is best purchased from somewhere else other than the vet because it’s expensive and places like Chewy or Allivet have better prices.)

Anyway, I would ask them to check his ketones if you are not testing at home. Hopefully, he isn’t a cat who is ketone prone.

What is his current ProZinc dose? Have you increased it?

Good luck with the Libre sensor. Do you have a little shirt to put over it?

I just tested his sugars again, 133!! I’m guessing that’s why he felt nauseated? Unless my reading wasn’t right this morning for some reason, but that’s a big crash. I had a good sample this morning, so I don’t know. He got his shot at 5:30, but I read his glucose at 4:30 when he first woke me up vomiting.

He’s still on the 1.5 that the emergent vet said to switch to, his regular vet said to keep it at that until she can get more data. She’s been out for two weeks and it took a minute to get the libre. I’ve been using the app to track cause it’s easier on my phone than the spreadsheet. I don’t have any tester stuff left for ketones, I need to get more. He’s never had any issues before but I know that doesn’t mean anything.

I keep trying new wet foods daily and he refuses it all. At best I still can get him to eat tuna some days, which gives me much better glucose numbers. I wish he’d just eat wet foods daily

 

[tedsmom1]

Nausea can be treated with odansetron. Most vets will prescribe the pills but it is available as an injectable which your vet may have or you buy from Chewy with a prescription. The pills can be bought at any Human pharmacy with a prescription. The brand name is Zofran which people take.

Pancreatitis is very common in diabetic cats. Treatment is some combo of anti nausea, anti vomiting, appetite stimulant, and pain med. The vet can do a FPLI blood test to diagnose.

There's info on using the Libre here: Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats

A Libre is more expensive than a manual meter and is known to fall off or malfunction before the 2 week change date. If your cat will let you test from the ear or paw pad, that would be ideal and cheaper. Even if you use a Libre, you need to know how to manually test if the Libre isn't working or falls off.

Yeah I test him before each shot. I test him and then feed him, make sure he eats, then shot. The vet wanted him to try a libre so she can have a lot of data, she said she tracks a lot of diabetic cat clients with libres and it helps find the right dose. I do think Ted will hate it and try to pop it off, but I wanted to at least try.

 

[Suzanne & Darcy]

I find that a lot of cats feel really unwell in the high BG numbers. Many won’t eat.

Don’t be too disheartened by the bloodwork yet. When cats are newly diagnosed or in very high BG, you will see a lot of impacts in the bloodwork and many of those things, including kidney values such a BUN, Creatinine and SDMA can improve as you get better glycemic control.

 

[Suzanne & Darcy]

I just tested his sugars again, 133!!

133 is a very good number. Of course, it depends upon when you are seeing that in the cycle. Normal blood glucose in a cat is about 50-120. Good luck with the Libre. Just be aware that the Libre can over exaggerate the lower numbers (read inaccurately low in the lower numbers below 100-ish.) This is why a low number on the Libre, especially if it’s telling you the BG is 50 or below or in the 60s or 70s, you should manually check it with your handheld glucometer to verify the number. When I have more time, I can share some spreadsheets with you showing what I am talking about.

 

[tedsmom1]

133 is a very good number. Of course, it depends upon when you are seeing that in the cycle. Normal blood glucose in a cat is about 50-120. Good luck with the Libre. Just be aware that the Libre can over exaggerate the lower numbers (read inaccurately low in the lower numbers below 100-ish.) This is why a low number on the Libre, especially if it’s telling you the BG is 50 or below or in the 60s or 70s, you should manually check it with your handheld glucometer to verify the number. When I have more time, I can share some spreadsheets with you showing what I am talking about.

Well she called today with the results, and his levels were raised again so she said that means he has kidney disease. But with him having heart disease and diabetes as well, it’ll be a balancing act to keep him as healthy as I can. We have his yearly follow up with the cardiologist in August, they said they can do a scan of his kidneys and see where they’re at. I’m having a hard time with it. He’s my special boy who’s been there with me through everything. I just want him happy and healthy.

The Libre definitely stressed me out the first night. It woke me up to an alert of being low, was showing in the 60s and said was dropping. So I tested it with his regular tester and it read a little over 100. Then a few minutes later the Libre removed that low reading and said 90. It does that constantly I noticed, where it reads one number then later changes it as to what the final number is. I hope the data makes sense to the vet once it’s done.

 

[Suzanne & Darcy]

How old is Ted? I know how distressing the bloodwork results can be. The key to helping to spare his kidneys is to keep his BG below say 200 for most of the time. Is he on any heart medications to help heart function? They always say the heart trumps everything, but you will still need to keep the BG down as much as possible and help his kidneys as much as you can. My heart goes out to you. I am glad you have a cardiologist on your team to help you. Ours was invaluable to us.

I see you have already experienced what I call the “Libre lows.” You did just right to test and check it.

 

[Suzanne & Darcy]

Do you know what his Creatinine, SDMA, BUN and USG are?

 

[tedsmom1]

How old is Ted? I know how distressing the bloodwork results can be. The key to helping to spare his kidneys is to keep his BG below say 200 for most of the time. Is he on any heart medications to help heart function? They always say the heart trumps everything, but you will still need to keep the BG down as much as possible and help his kidneys as much as you can. My heart goes out to you. I am glad you have a cardiologist on your team to help you. Ours was invaluable to us.

I see you have already experienced what I call the “Libre lows.” You did just right to test and check it.

He just turned 15 this July. He’s currently not on anything for his heart, when we saw the cardiologist last year he said he had mild enough heart disease he didn’t want to put him on anything yet, but wanted a year follow up. Which is beginning of August. So I guess it works out seeing him same time I need advice on his kidneys.

I’m attaching what his bloodwork said on those numbers. I know I need to find a food he’ll actually eat that works for everything. He’s so stubborn and picky it’s making things worse. And I’ve had multiple vets now tell me cats are so stubborn they’d literally starve to death than eat something they don’t want to. Said dogs give in, cats generally don’t. And boy Ted is proving that to me with his refusal of pretty much everything.

 

[Suzanne & Darcy]

He just turned 15 this July. He’s currently not on anything for his heart, when we saw the cardiologist last year he said he had mild enough heart disease he didn’t want to put him on anything yet, but wanted a year follow up. Which is beginning of August. So I guess it works out seeing him same time I need advice on his kidneys.

I’m attaching what his bloodwork said on those numbers. I know I need to find a food he’ll actually eat that works for everything. He’s so stubborn and picky it’s making things worse. And I’ve had multiple vets now tell me cats are so stubborn they’d literally starve to death than eat something they don’t want to. Said dogs give in, cats generally don’t. And boy Ted is proving that to me with his refusal of pretty much everything.

Those kidneys values aren’t too bad. Just barely out of range or at the upper end of normal. Right now, I would focus on trying to feed him lower phosphorus foods (of course whatever he hopefully will eat.). Hydration is very important also. Add water to his food if you can or try a fountain. Some cats like the Purina HydraCare.

I hope you can get some wet food he will eat. I have had good luck with one of the Weruva foods called Press Your Dinner. I feed a few other of their foods and most recently some of the Wx foods which are very low in Phosphorus.

Doesn’t the Young Again Zero Mature dry food have low phosphorus (as well as low carb)? I will have to recheck that with my food charts.

 

[Suzanne & Darcy]

Yes. The Young Again Zero Mature dry is low phosphorus. See the attached Diabetic CKD food list. Maybe you can find a wet food her will eat too. Some people find freeze dried food provides enough crunch for chicken lovers. My cats love crumbled up Pure Bites Chicken on top of wet food, but I don’t think they’re low in phosphorus. I wonder if anyone makes boneless chicken pieces that are freeze dried. Anyway, here’s the list.
https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf

 

[tedsmom1]

Those kidneys values aren’t too bad. Just barely out of range or at the upper end of normal. Right now, I would focus on trying to feed him lower phosphorus foods (of course whatever he hopefully will eat.). Hydration is very important also. Add water to his food if you can or try a fountain. Some cats like the Purina HydraCare.

I hope you can get some wet food he will eat. I have had good luck with one of the Weruva foods called Press Your Dinner. I feed a few other of their foods and most recently some of the Wx foods which are very low in Phosphorus.

Doesn’t the Young Again Zero Mature dry food have low phosphorus (as well as low carb)? I will have to recheck that with my food charts.

He does have a fountain, since he was a kitten. He LOVES his fountain, drank well from it even before his diabetes. I also get him to drink more by giving him ice with water from the fridge. I offer him “fresh ice and water” a couple times a day and he immediately comes to drink it. He loves ice. So I’ve been doing that a lot to get him to drink more.

And I actually tried to give him the Young Again Zero Mature back when I was trying to find the best dry food. I found the list on here a long time ago looking for something better and ended up buying almost every brand on it, some different flavors even. The only thing he accepted was the Epigen 90. I may try it again tho. From searching around on here and Reddit, some suggested Forza 10? I may grab that too.

 

[tedsmom1]

Yes. The Young Again Zero Mature dry is low phosphorus. See the attached Diabetic CKD food list. Maybe you can find a wet food her will eat too. Some people find freeze dried food provides enough crunch for chicken lovers. My cats love crumbled up Pure Bites Chicken on top of wet food, but I don’t think they’re low in phosphorus. I wonder if anyone makes boneless chicken pieces that are freeze dried. Anyway, here’s the list.
https://www.bizave.com/foodlists/CKD Diabetes Food List.pdf

Oh thank you! I’ve only seen the diabetes list! I’ll look this over and find some more things to try.

Thank you so so much for helping me and responding. This is all a lot and it’s nice to have someone who understands it all.