4/1 Maximillian... Who's foolin' who?

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Maximillian's Person

Member Since 2009
Last night there was no PM shot. Not because I was afraid to shoot a lower number (140-150 was my low number with N!) but because my 6 year-old nephew went to the ER. He's fine. But, at +14 when I tested Maxie, he was at 143.

This morning at what would be +23, I guess, he was 148. Shot the .25 again. Tested at +1 and he is at 146. Plan to get a +3 if he doesn't do anything strange in the next couple of hours.
 
You are right to be cautious about giving insulin or giving a full dose right now because you don't have data to show how Maxie will react. So, trust your instincts there. As you get more data on various PS numbers you will know if it is safe to shoot or not.

I hope your nephew is OK.
 
Day 2: amps 148. gave .25U. +1 146. As I was gathering materials for +3, he vomited. This was a common occurrence with N when his numbers would get low. +3 was 34. I gave him some Friskies Turkey Dinner in Gravy (prime fillets) which he loves and he sniffed and walked away, so I gave 5 Blue Buffalo crunchies. He ate those and a bite or two of the canned. Checked 15 minutes after snack. Down to 28. Gave another bite of canned in gravy and 5 Tempations. Then gave about a quarter teaspoon of honey from a feeding syringe. He's wandering around giving me the stink eye now.
 
Keep testing every 15min; the gravy and karo don't last long and you want to make sure the numbers keep coming up.
 
Wow - glad you saw the signs and tested.

I used to mix a little Karo into FF for Beau so that the karo gave a little spike and the FF, hopefully, held the BG up after the karo wore off.

You want to stay with this through about +8 to make sure he is staying up. They can drop again because of lev's long action especially when the low was before +5-ish. This is almost exactly what happened to Beau on his 3rd shot of lev, but he didn't drop that low (37). And he was then at 380 at pmPS, so you can probably expect a high number tonight.

Of course, you want to reduce his dose. I think the .1u I mentioned would be good. Did you find the photos to draw .1u? Maybe practice this afternoon with an old syringe and some water until you feel comfortable. If he is really high tonight, you might want to give a little more than .1u - maybe .15u and then go to .1u tomorrow am.
 
+4.25 = 35, gave some more canned and crunchies. +4.5 = 23. Not interested in food. Giving honey again. NOW he's beginning to be lethargic. Ugh...
 
+5.75=22. Rubbed more honey on his gums. Refusing all foods even Temptation treats and his chewy vitamins he normally begs for.

He only ate a bite of the raw chicken. Has schmorgasborg available to him including 2 types of dry, canned with gravy, raw chicken thigh an Temptations. Not interested at all.
 
hi donna. what do you think about taking him to an ER since he's not interested in eating and you're having trouble keeping him out of the 20s?
with long acting insulins, you could be fighting low numbers for hours. ER is where i would be headed... along with karo/honey to use on the way.

just my thoughts...
 
I think ER is a reasonable solution. It sounds like you're fighting pretty hard and he's still not coming up. They can manage this easier than you can at home.
 
Jill, if I were a total newbie and/or he were showing symptoms I would whisk him off in a heartbeat. Honestly, he is asymptomatic (a little lethargic earlier, but snapped out of that) and would take himself to the 30s without insulin over the past 5 years. I believe that this is really his own pancreas joining the party. I will continue to watch him and if he shows any more symptoms, I will take him to the ER vet.

Right now he's just mad at me for poking him so much today. He's begun to run from me when I go to test him.
 
you'll need to test every 15 minutes while he is in the 20s, then every 30 minutes until the bounce starts. Do you have a lot of test strips and HC food and syrup? We have seen this go on for hours, sometimes until +16 or so. Are you ready for that?
 
i know you're not a newbie, but libby's right. there's an increased chance of prolonged hypoglycemic events with the long-acting insulins. we have seen these events last 16 - 17 hours. if maxi was coming up easily, i wouldn't be suggesting ER.
 
That 14 is definitely scary to me. I hope you'll consider bringing Maxie to the ER. We only want to see him safe. Please check in when you can.
 
just checking for an update. although, i'm hoping you've reconsidered about going to an ER.
please update when you can. have to go out, but will check back when i get home.

(((hugs)))
 
Hi Donna,

How's he's doing now?

You may need to administer honey or syrup rectally if he becomes unconscious. Here are the full instructions from the Hypo post in Health:

LOW NUMBERS – SEVERE SYMPTOMS
Rub syrup, honey, or glucose on the gums and cheeks if your cat will allow it. Another option for administering syrup, diluted liquid glucose, honey or sugar syrup to a cat who is seizuring is to fill a needleless syringe with the mixture and insert via the rectum.
NEVER TRY TO SQUIRT SYRUP, HONEY, OR GLUCOSE TO A CAT WHO IS SEIZURING AS THE CAT COULD CHOKE ON IT! RUSH TO EMERGENCY.

AGAIN! ANYTIME YOU CAT IS SEIZURING OR LIMP, RUB KARO, GLUCOSE OR HONEY ONLY ON GUMS OR ADMINISTER RECTALLY AND GET TO EMERGENCY OR YOUR NEAREST CLINIC IMMEDIATELY!!!

Remember that syrup or any other sugared syrup/preparation will spike the blood glucose ONLY for a short period of time, so food is really important with mild and moderate symptoms. Dry food (high carbohydrates) will keep the blood glucose numbers elevated longer, so it’s a better food to give during a hypoglycemic episode.

After a hypoglycemic episode cats may be more sensitive to insulin, so a reduction in dosage is generally required, especially considering too much insulin – whether due to dosage, inadequate food intake, or the cat’s changing insulin requirements – caused the hypoglycemic event in the first place. With moderate to severe episodes, your Vet may have you skip the next injection altogether.
IT IS VERY IMPORTANT THAT YOU DISCUSS YOUR CAT’S HYPOGLYCEMIC EVENT WITH YOUR VET, SO TOGETHER YOU CAN DECIDE UPON THE NEXT COURSE OF ACTION.

Always keep in mind that with low blood glucose and no symptoms, the BG you get is not as important as where it is headed. In other words, if you get a BG of 100 mg/dL or 5.6 mmol/L or less and there are still several hours or more before the insulin peaks, your need to watch your cat (and the numbers) carefully and take appropriate steps. With very low numbers and NO SYMPTOMS, a cat can be fine one moment and seizuring the next.
Click to expand...

I want you to have them because sometimes when there's a crisis we don't know where to look for info. It really sounds like you know what you're doing, but you have your hands full. You have to get food and sugars in to him. And you may have to keep giving it to him until we get steady rising numbers and it's past +12. Yes, hypos on the L's can last a long time.
 
His last test at +8 was 48. He has been asymptomatic the entire time. I will still test him and keep sugaring him as necessary. I am now trying to get some food into him now. He has no interest in even crunchies still. Will try spoon feeding him some runny/watery canned food into him.

I am doing fine. This is not my first rodeo, unfortunately. Before I was in the Dallas/Ft. Worth area and now I live in a small town in the Texas Panhandle. I had all I needed and was prepared for this. He has quite a bit of pancreatic activity on his own and I am very sure that part of these low numbers are his pancreas going, "oh, hey. I like these numbers. I think I'll help out." And so it did.
 
good, 48 is much better than 20s. :smile: Unfortunately you'll have to keep at it for a while. You've already seen that he can drop back down as the sugar wears off, and you don't know yet what his nadir and duration are on Lev. Judging from yesterday's numbers, it looks like it is pretty long. Food should help give him a longer lasting bump than the syrup by itself, if you can get some food in.

sending hugs for you, you're doing great.
 
:-D

Glad to have someone using Levemir who's on the ball. Sounds like he may be on the rise. And honestly, if it were any other insulin you might have been in more serious trouble.

It has been noted in humans that Levemir has "less incidence" of hypoglycemia events. We see very few symptomatic hypos on Levemir, even with low numbers, yes below 30. I have seen as low as 21 with the only symptom being excess hunger. Not sure why the hunger part didn't happen to Maxie, but this possibly was his pancreas playing ball with the Lev so maybe that's why.

Given that, this event may have jump started his pancreas, so I caution against giving him any insulin unless he's over 200. He may rebound or he may not. And as Sheila suggested, a drop will probably be sufficient to keep him in normal BGs.
 
I just syringed in some watery food and honey so that he'll have something besides sugar on board. He's back in the 20s. He's sniffing the food, even taking a lick or two. Nothing is enticing him to eat (he hates parm cheese, by the way). I'm going to keep syringing in the sugary food until I get about 3 or 4 tests over 40.

I am hoping that this is enough to jump-start his system so that he only needs a sniff or two of insulin occasionally.
 
OMG, what a day you've had! I hope he is on the way up and stays up for you - and eats!

The lowest I ever saw on my guys was 27, but that was about 20 mins after Beau started acting a little out of it and it finally dawned on me to test (geez). He was trying to eat from an empty dish when there was one with food in it a few feet away - licked the empty one clear across the room.

My experience with Beau, when he was headed OTJ is different than others I have seen here. I could not shoot even .05u on a number below 150 or he dropped into the 30s. You may find that Maxie only needs occasional help from the exogenous insulin - as needed - and only in the smallest amounts. I am thinking .1u max, but .05u might be safer - and only above 150 until you find the right "do not shoot" number for him.

Practice, practice with the syringe and the drops. You will learn what a .1u drop looks like and can eyeball half of that (.05u - even a fourth of that, if you want to go to .075u). Get your reading glasses or magnifier out - and a good light to work under.
 
Oh dear, just read your update.

Common, Maxie, eat for momma - bring those numbers up, buddy!

Donna, we are all sending "BG up" thought to Texas. Hang in there, you are doing great.
 
come on up and stay there please, Maxie... From your spreadsheet it looks like he is in the 30s now?

Maxie, why don't you eat a nice big HC meal so mom can quit poking you so much?

I'm sure this won't take much convincing, but I think it would be smart to skip his shot tonight, even if he bounces. Let the Lev clear out of his system and then reassess tomorrow. And I think it's pretty safe to say that he doesn't need as much as 0.25u.
 
Just keep at the food with him, Donna.

I don't suppose you are 5 or 10 minutes away from a store which would have Fancy Feast, are you? Their grilled varieties are high in carb and I have never met a cat which didn't love them!

The BGs aren't stabilizing because sugar is short acting. He needs high carb food. Would he eat the food if you mixed the sugar in it? Some cats love sugar, Gandalf was one. He would lick syrup off my fingers, so I never worried about him eating during low numbers.

The parmesan cheese is a good idea. But the food needs to be high carb. Try not to use dry, since it takes a while to process. I suppose you could soak it in water or milk and mash it up. Milk gives some cats diarrhea though so be careful with that.

What about meats you have? Do you have any sugar cured ham? I know it's not good for them, I'm just trying to think of things you might have which he might eat.
 
I have been syringing food mixed with honey for the past hour or so. He's back up to 49 as of +10 and 59 as of +10.5.

Yeah, Libby, he's NOT getting a second shot tonight. Depending on what he is in the morning, he won't get one then, either. He also won't be getting a .25 shot again. I'm thinking a fat 0 might be it.

I am going to leave him be for a bit. I syringed in about 3 1/2 teaspoons of watery food and he is so not hungry right now.
 
hopefully he is turning a corner now. I wouldn't wait any longer than an hour to test again. He's still not looking very steady yet - every time you get him up, he goes back down when the syrup wears off. Hopefully the food will help him stay up this time, but better safe than sorry.

You're doing great, hang in there. :smile:
 
Calmest hypo watch? Eh, I was a little panicked at a 14, but he never showed symptoms or only mild ones. A lot of the calmness was the fact that I have done this before ... these are the lowest numbers I have ever seen ... and I've done my homework. I knew what to expect. I had what I needed and I used it. Over panic doesn't solve anything. I knew when I started on a Sunday that I was on my own because I don't have a new vet here and the ER vet is about 40 minutes from my house (if not more). His +12 was 53.
 
ahhhhh, 50s are so much better! :mrgreen:
as tired as i'm sure you are... he appears to be surfing the 50s, but you'll want to continue monitoring until you see a good rise.

is he eating on his own?
 
Whew! You have earned some rest. I hope he is eating on his own and resting himself. He must feel like a pin-cushion, poor baby.


Yeah, 14 would have freaked me out that's for sure.
 
Great work Donna! :thumbup Wow, this thread is exhausting just to read - I can't believe how tired you and Miximillian must be now.

Here's hoping the little bit of insulin woke up his pancreas like you say and that now he may not need much, if any, more. Crossing paws, toes and tails...
 
Wow Donna. I remember you. I am sorry I wasn't here to offer any advice but you got the very best here helping you.

IMHO I would go with no insulin and just feed him his breakfast and see if he just brings himself down on his own a couple of hours later or less. I would do this for a cycle or two and see where he is at then. Clear out all those carbs and then go from there.

He doesn't sound like a kitty that needs insulin. The stress from
moving....it makes you wonder on these borderline diabetics what little it can take. I hope that is all this was.

Keep us posted!
 
Donna, I am wondering what type meter you're using? We have always assumed most meters are less accurate with higher BGs and that the ones that really matter, below 100 are fairly accurate. Then again there is another assumption that meter manufacturers err on the side of caution and make them read lower than actual below 50 so that people respond quickly to prevent a human hypo.

There have been recent discussions about the Freestyle meter being very inaccurate and reading much lower than actual.

Glad he's doing OK. Glad you're doing OK too! I said "calmest hypo" because you sounded in-control and knowledgeable and not panicked. My apologies to anyone who read my "glad to see someone on the ball using Lev," and felt that was a put down to anyone else! I only meant it to support Donna and didn't think about how that came across to anyone else reading it when I wrote it :oops:
 
Vickie, I hope anyone who read your comments took them in the spirit intended. In all honesty the only reason I was so calm is because I have done this before. I had support (here and from old FDMB friends who aren't on the board any longer). I had my hypo kit stocked and ready (very, very important). Knowledge with preparation make for calm.

Maxie and I are doing okay this morning. He was 113 at AMPS time. No shot, obviously. Unfortunately, this morning he is refusing food, still drinking water, but is running from me today. I don't honestly blame him. I tested him 30 or so times yesterday. Near the end of testing, I was having trouble getting blood. I felt/feel awful for what I did to his poor ears. (I know it was a necessary hurt, but guilt is a bitter pill and irrational.)

As for meter. I was using his Bayer Contour. It is the one I've used (well, one just like the one) since his AccuCheck Active crapped out on me. This is his second Contour. DCIN helped me out with the insulin and sent a Bayer Contour USB. It wasn't fully charged yesterday, so I used his. The strips they sent worked with his meter.
 
Yeah, poor Maxie! You might try some Neosporin on his ears if they look icky.

The Contour's supposed to be very good meter. Oh, I believe you also win the "Lowest BG on record award" here!
I used the Aviva and it would only read LO below 20. I tested a 21 once. Again, no symptoms other than hunger.
 
Lowest on record, huh? Not a great record to hold, IMO. :?

Oh, and part of the reason I was so calm yesterday... I did the whole thing with a migraine headache. The +2 number I needed was missed because he and I both fell asleep in a sunbeam. I had to stay calm because that was the only way I could think.

I think in a lot of ways today is worse than yesterday. He feels like crap today. I feel guilt for shooting him so low (guilt is irrational...).
 
The Contour is what I use for Musette and its a really good little meter. I missed all the fun over here, since Musette was pulling the same stunt last night, but she didn't go anywhere near as low as Maxie so he wins this round. :-D Her low for the night was 31 and that was at 4:30 this morning...I need a nap!

Mel, Maxwell, Musette & The Fur Gang
 
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