08/19/18 Maddie AMPS ?Hypo?

[MaddieM]

Hi I'm new at this so please forgive anything that I don't do right. Maddie has been on Lantus just under 2 months. She's been getting Lantus 1 unit twice a day using a pen. Everything's been going fine. She is a ravenous cat she always has been. She normally starts yowling/begging incessantly several hours before meal time which is 12 hours apart. I've been giving her the shot while she's eating near end of meal. Last night's shot was given right at the start of the meal, I don't think she'd had much food yet. When I came in I noticed she was acting strange laying at the dish and picking at the food and it was taking much longer than normal to get it down she still had interest but definitely wasn't acting normal. I kept trying to get her to eat the food and eventually she did but it probably took about 30 minutes compared to the normal 2 minutes. She seemed kind of confused and the food was all over the floor. (Switched to low carb canned after diagnosis). It's the weekend so I can't call the vet. I didn't give her her shot this morning because I was too concerned. Does this sound like it could have been a hypo event? After about an hour she seemed pretty normal. She has always been a large cat, had eaten ravenously all last winter on a nasty prescription kidney diet even though that diagnosis was questionable, dramatic weight loss in the Spring brought us to this diagnosis. I now know I likely need to get a meter, will do that today. We started a new pen 3 days ago. There was a bit of diareah in box the next day, with two cats I can't say for sure it was her. Sorry this is long. Last night scared us. Just wondering if what we witnessed was mild hypoglycemia.

 

[Nan & Amber (GA)]

Yes, that could very well have been a symptomatic hypo. Lantus doesn't really take action until at least an hour or two post-shot, but she could have actually still been going low from the previous shot. You don't really know without testing, but it wouldn't be unusual for the switch to low-carb food to have a dramatic effect on insulin needs. It's possible that she's been going very low regularly in the middle between the shots-- both extreme hunger(even if she normally often acts hungry) and loud vocalizations can be symptoms.

Really glad you're getting the meter and starting to test! Be aware that some cats can be more sensitive to insulin after a symptomatic hypo, so it's good to be extra-cautious after what you witnessed. You'll want to have something high-carb at hand to feed her when she goes low-- the gravy from a higher-carb canned food is good for a quick boost. When you really need her BG to come up quick, a small amount of honey or karo syrup is good (you can rub it on the gums if she doesn't want to eat it).

Maddie is absolutely adorable, by the way!

 

[tiffmaxee]

I’m don’t know where you live but the ONLY way to know what’s going on. A hypo can be deadly so you are right to be concerned. Which insulin are you using? If you live near a Walmart go there and get a Relion Micro or Confirm, an extra box of strips, some lancets for alternative areas as they are I believe 28gauge, U 100 syringes with 1/2 unit markings, some food with gravy in case she goes to hypo, Karo syrup, younneed to test before you shoot at a minimum and again 2-5 hours after injecting if possible. Please read all the yellow stickies. They explain how lantus works.

 

[MaddieM]

Yes, that could very well have been a symptomatic hypo. Lantus doesn't really take action until at least an hour or two post-shot, but she could have actually still been going low from the previous shot. You don't really know without testing, but it wouldn't be unusual for the switch to low-carb food to have a dramatic effect on insulin needs. It's possible that she's been going very low regularly in the middle between the shots-- both extreme hunger(even if she normally often acts hungry) and loud vocalizations can be symptoms.

Really glad you're getting the meter and starting to test! Be aware that some cats can be more sensitive to insulin after a symptomatic hypo, so it's good to be extra-cautious after what you witnessed. You'll want to have something high-carb at hand to feed her when she goes low-- the gravy from a higher-carb canned food is good for a quick boost. When you really need her BG to come up quick, a small amount of honey or karo syrup is good (you can rub it on the gums if she doesn't want to eat it).

Maddie is absolutely adorable, by the way!

Thank you, very helpful. I had the same thought about the extreme hunger and the vocalizing. Hoping I am successful with the testing.

 

[MaddieM]

I’m don’t know where you live but the ONLY way to know what’s going on. A hypo can be deadly so you are right to be concerned. Which insulin are you using? If you live near a Walmart go there and get a Relion Micro or Confirm, an extra box of strips, some lancets for alternative areas as they are I believe 28gauge, U 100 syringes with 1/2 unit markings, some food with gravy in case she goes to hypo, Karo syrup, younneed to test before you shoot at a minimum and again 2-5 hours after injecting if possible. Please read all the yellow stickies. They explain how lantus works.

 

[MaddieM]

Thank you. I am using the lantus pen at the lowest dose so I can't really fine tune it downward. Off now to buy a meter.

 

[Sandi and Toby]

Here is the shopping list that I keep stealing from @JanetNJ : http://www.felinediabetes.com/FDMB/...-them-in-the-right-place.197437/#post-2209177

And most of us don't use the pen needles on the lantus/Levemir pens, for exactly that reason. We insert a syringe into the rubber stopper on the pen and draw insulin out of it just like it was a vial, so that you can finetune doses. Read through this: http://www.felinediabetes.com/FDMB/threads/syringe-insulin-info-handling-drawing-fine-doses.151/

And you should also know these:

http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

So also pick up some honey or Karo syrup, and a few cans of Fancy Feast Gravy Lovers food for emergencies.

 

[MaddieM]

Here is the shopping list that I keep stealing from @JanetNJ : http://www.felinediabetes.com/FDMB/...-them-in-the-right-place.197437/#post-2209177

And most of us don't use the pen needles on the lantus/Levemir pens, for exactly that reason. We insert a syringe into the rubber stopper on the pen and draw insulin out of it just like it was a vial, so that you can finetune doses. Read through this: http://www.felinediabetes.com/FDMB/threads/syringe-insulin-info-handling-drawing-fine-doses.151/

And you should also know these:

http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

So also pick up some honey or Karo syrup, and a few cans of Fancy Feast Gravy Lovers food for emergencies.

Thanks ! So much to know. I had no idea that you could use a syringe with the pen.

 

[Sienne and Gabby (GA)]

You absolutely can use a syringe with the pens. In most states you need a prescription for syringes, though.

 

[MaddieM]

Well it wasn't pretty but I got the first home test done, it was 152 mg/dl with her last insulin 23 hours ago when we had the scare, and her last meal 11 hours ago. That doesn't seem very high, on the other hand she hasn't eaten. Hesitant to give her her evening dose now. Will call vet in a.m.

 

[Sandi and Toby]

It is not high, relatively speaking. Since you are only two months in, having eating problems, and have limited home testing data -- I would agree with skipping tonight.

P.s. Good job on your first test!

 

[Nan & Amber (GA)]

Whoo-hoo! First test done! Gets easier from here (well, mostly!).

I agree, best to skip tonight.

Is she having eating problems, or do you just limit to two meals a day for other reasons? If it's possible with your schedule, feeding more frequent small meals seems to be a good thing for diabetic cats.

 

[Sandi and Toby]

Wait a minute...one more thing. The math wasn't working for using 1 unit twice a day for only two months, but being on your second pen already. Hmmm... Two possibilities I have to say so that I can sleep with a clear conscience tonight

1) So I just read the instructions for using a pen needle (as I mentioned above, I've never done that), and saw that you basically are supposed to shoot two units into the air every time first. So if that is what you are doing, the math works to already have used a whole pen already. The good news if you switch to a syringe is that, while you will still probably draw out a hair more than needed and then adjust down to get rid of any bubbles, you won't waste a full two units twice a day! And of course you then Also have full adjustability for half unit doses. But know that you should then keep the pen in the fridge, which you might not be doing right now for the pen that is currently in use. And if you do move to a syringe, since you've just been dialing to '1' now, know that one unit is TINY, like the thickness of a fingernail. There is a diagram that we can show you if there is any question.

2) Or if I am wrong about priming...I want to make sure that you didn't just throw the first pen away even though it wasn't empty. Many people have been told that pens are only good for 28 days, or two months, or whatever other arbitrary time period after opening...and that just isn't true, so I didn't want to pass up the opportunity to mention this. It should be good for more like 5-6 months or longer.

 

[MaddieM]

Wait a minute...one more thing. The math wasn't working for using 1 unit twice a day for only two months, but being on your second pen already. Hmmm... Two possibilities I have to say so that I can sleep with a clear conscience tonight

1) So I just read the instructions for using a pen needle (as I mentioned above, I've never done that), and saw that you basically are supposed to shoot two units into the air every time first. So if that is what you are doing, the math works to already have used a whole pen already. The good news if you switch to a syringe is that, while you will still probably draw out a hair more than needed and then adjust down to get rid of any bubbles, you won't waste a full two units twice a day! And of course you then Also have full adjustability for half unit doses. But know that you should then keep the pen in the fridge, which you might not be doing right now for the pen that is currently in use. And if you do move to a syringe, since you've just been dialing to '1' now, know that one unit is TINY, like the thickness of a fingernail. There is a diagram that we can show you if there is any question.

2) Or if I am wrong about priming...I want to make sure that you didn't just throw the first pen away even though it wasn't empty. Many people have been told that pens are only good for 28 days, or two months, or whatever other arbitrary time period after opening...and that just isn't true, so I didn't want to pass up the opportunity to mention this. It should be good for more like 5-6 months or longer.

Hi, first off, I did hold off tonight, I really appreciate all the assistance today. It really helped to hear from others that have been through this. I did not ever prime, I took my lesson from the vet and it never came up. I later read about it and looked online and found varying opinions. I normally see a drop at the tip. I also, after careful review and consideration, violated the 28 day rule. I want to do what's best for Maddie but also need to watch the $$$s. Trying to find the right balance, if I can test myself and not have to take her in for the curves it will help a great deal.

 

[MaddieM]

Whoo-hoo! First test done! Gets easier from here (well, mostly!).

I agree, best to skip tonight.

Is she having eating problems, or do you just limit to two meals a day for other reasons? If it's possible with your schedule, feeding more frequent small meals seems to be a good thing for diabetic cats.

You know I've been wondering about this and think you are probably right. I don't know why I had it in my head that she should eat only at the time of her shots. She'd be very happy to eat more frequently. I definitely can't just let her self feed though as she doesn't stop. When I first got her I was used to putting food out for my previous cats and did the same with her until she got to 25 plus lbs. I could split her measured meals up though. I'll look into this. Thank you and thanks for the encouragement today.

 

[tiffmaxee]

Congrats on testing! It took me a lot longer! You can save money by getting future insulin from Canada. Lots but from Mark’s Marine Pharmacy. I did ! Many use an auto feeder successfully when they can’t be home. Keep posting and asking questions as there’s almost always someone here to answer.

 

[MaddieM]

Congrats on testing! It took me a lot longer! You can save money by getting future insulin from Canada. Lots but from Mark’s Marine Pharmacy. I did ! Many use an auto feeder successfully when they can’t be home. Keep posting and asking questions as there’s almost always someone here to answer.

Thank you for the info. I'm hoping the testing gets easier for both of us. She doesn't like it. Fingers crossed.

 

[tiffmaxee]

The key is a treat after every poke. I used freeze dried chicken or turkey.

 

[Sandi and Toby]

Another option is massive luvins at pokey time. Even though Whispy is VERY FOOD MOTIVATED, as can be seen by his portly physique, he comes over and starts purring for me, and I get him massive chin skritches and rub all over his head before we do our poke. No treats necessary for us.

Moral of the story...Whatever works!

 

[MaddieM]

Another option is massive luvins at pokey time. Even though Whispy is VERY FOOD MOTIVATED, as can be seen by his portly physique, he comes over and starts purring for me, and I get him massive chin skritches and rub all over his head before we do our poke. No treats necessary for us.

Moral of the story...Whatever works!

Thank you! That's my motto these days too.

 

[MaddieM]

The key is a treat after every poke. I used freeze dried chicken or turkey.

Maddie wants to move in with you. Kidding. Treats are a good idea. I actually tried doing it yesterday morning just as I put her food down and that was better. Part of the issue is my technique. As I get better on locating the right spot and how hard I have to poke things should improve. I had a curve done at vets yesterday. Haven't had formal conversation yet but sounds like we'll stick with the same dose for now and see what happens.

 

[tiffmaxee]

Max wasn’t a foodie until diabetes. The freeze dried really helped and when I had to start fluids were a life saver. The first time he ran and hid when done and he wasn’t moving fast at that point. He got a special treat right after the second time and from then on he waited for his treat if I forgot it! I promise it will get easier and soon you will be able to do your own curves. Max always tested higher when at my vet’s office due to stress. More easy going cats might go lower but my cats are always stressed when they leave home.