Austin had a severe hypo today-UPDATED-he's home!

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4xchooks

Member Since 2010
I've just got back from the emergency vet after taking Austin in having a severe hypo. He'd defacated all over himself, jaw was clenched, fitting, stiff, non responsive, and a temp of 32 degrees celcius. Hi BG was 1.8.

He's been on 4 units twice a day of Lantus for a few weeks now and his BG has still been in the high 20's. In the last week, all I've changed is cutting out any dry food and feeding him up to 3 times a day wet food or fresh meat. The vet said to me that Hills MD is the best for diabetic cats, but when I said about his food changes and asked her how that alone has brought his levels down so low, she couldn't answer me.

His BG was up to 15.6 when I left the vets. She gave him 5ml of a glucose solution and we've left him there overnight hooked up to a drip. He was purring and able to hold his head up when I left, but still unable to stand and his eyes were still glassy. His temp was still way too low (I don't know what the reading was) so he's on a heat pad with a hot water bottle, and a blanket over him.

I guess I'm posting this to a) get it out and b) to ask if what his chances are of making it through? The vet was pretty negative/cautious and didn't give me any hope.
 
Re: Austin had a severe hypo today

Hi 4xchooks and Austin. I don't know what the numbers you are posting mean because I am used to the American version.
I can give you cyber hugs and send my prayers and thoughts and cross my fingers and toes, that Austin pulls through and is all better soon.
 
Re: Austin had a severe hypo today

I only recognize 4 units of insulin, maybe Austin is on too much to start. Sending get better vibes and never give up hope.
 
Re: Austin had a severe hypo today

I am glad you have removed the dry food, but you now see how much of an effect it can make.
I don't think you will be needing such a very high dose of insulin now.
You may want to start over, at 1u twice a day, then work your way up to a good dose for Austin, now that you are feeding a better diet.

The dose of 4u was likely OK because of all the dry food being fed; the dry can have a horrible effect on numbers. My Shadoe will have numbers up in the 400s or higher, (over 22.0) if she eats even a small mouthful of dry food.

Thank goodness Austin survived, and you are now able to see how much insulin he really needs.
 
Re: Austin had a severe hypo today

Thanks everyone. :-)

Gayle, do you think he's likely to recover? Is that your experience/understanding?
 
Re: Austin had a severe hypo today

I honestly cannot comment on how kitties are with surviving, but they are pretty tough, so let's hope he's well on the road to recovering nicely. Others will be along shortly to give you more advice and info.

For those who don't recognize the number, 1.8 mmol/L is 32 mg/dL.

It may be helpful to use the convertor for your BG numbers when posting; I made myself a sheet of the numbers for reference and posting.
http://www.felinediabetes.com/bg-convert.htm

Do you have a sheet with Austin's BG numbers from your testing? It would be helpful to see the info and better help.

What did your vet say about dose now, and what have you done so far this morn.
Last but not least, how is Austin doing and acting.
 

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Re: Austin had a severe hypo today

Good morning 4xchook and Austin. Sending some positive vines and white light for Austin at the vets. I hope you have your boy back at home with you soon.

That dry food can really wreck havoc on a diabetic kitty's system, and I can personally testify to that! Spot got one tiny piece of the droolers food and his bg went pretty high and it took over 24 hours for it to clear. So, now that you have taken the dry food out of Austin's diet, his bg's should be lower and you will now need to adjust his insulin because 4u will be to much for him. Gayle suggested starting over at 1u, which is a pretty good starting point. If Austin needs more, than you can adjust it by going up .25u until you get to his ideal dose.

Please post whenever you get news on Austin today.
 
Re: Austin had a severe hypo today

Thanks everyone. I definately be in tomorrow to update on Austin. Right now, I'm just trying not to beat myself up and praying he makes it through.
 
Re: Austin had a severe hypo today

Do not beat yourself up over this incident; you are not the first and you certainly won't be the last, who believed in their vet's knowledge, trusting all advice and instructions given. Too many just are not as knowledgeable as we would like, so thank goodness for this board.
I have also had issues with my own vet office over my two, so don't worry.

Please do post anything and everything that you notice and want some feedback; while not everyone has experienced everything, you will find at least one person who can answer your question or send you in the direction to get an answer.

As I mentioned earlier, all BG numbers you have recorded from the past for Austin would be very good to post. Most people here keep track of the numbers in a google spreadsheet as it's free, easy to use, and everyone can view the info and help you quickly.
Spreadsheet Template and Instructions

It may be a little late, for the other day, but handy for you to keep:
List of Hypo symptoms
How to treat HYPOS – They can kill! Print this out!
Jojo’s HYPO TOOLKIT

here are the links for info on Lantus and the protocol:
Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

Some questions others will be asking and good reason to put together a bit of a profile:
1. general info - age, date of dx, other health issues.
2. diet - before and now, when changes made. NOTE: do not feed for 2hrs prior to shots as the food will raise Austin's BG numbers.
3. type of insulin - instructions from vet when first dx, dose given, times of shots, how increases were decided and when.

Lantus, 4units twice a day, is pretty high, but that dry food may be what has been saving Austin from an earlier hypo incident.

Be sure to post if you notice anything out of the ordinary about Austin now, and it may be a good idea to post what Austin's BG is before giving his next shot.
 
Re: Austin had a severe hypo today

Agreed. Many Vets just don't seem to have the right information when it comes to treating diabetes. Mine had Kazi on dry prescription food, a terrible insulin and no home-testing. Luckily I found this board and they set me straight. ;-) I will be keeping Austin in my thoughts- I hope he continues to improve by leaps and bounds throughout the day!
 
Re: Austin had a severe hypo today

You are in the right place to get Austin back on track. I will be thinking about the both of you today and can't wait to hear an update. Glad to hear Austin was purring when you left!
 
Re: Austin had a severe hypo today

I hope all goes well with Austin today. I have been through hypos with my guy, and he has survived them. This board is awesome, lots of help and answers here. Please keep us updated on how Austin is doing. It is good that he was purring when you left him last.
 
Re: Austin had a severe hypo today

Sending Healing Vinea to Austin--What vets dont know about FD could fit in an encyclopedia--Here we study this disease every day--Glad you found us--Ask for dosing helpers--Tomorrow is another day! We are here to help you 24/7
 
Re: Austin had a severe hypo today

I hope Austin is home soon.
My baby, DC, had a severe hypo May 15/10. His BG was 1.2 when I got him to the vet.
He was having seizures, wailing, pooped on himself during one of the seizures and couldn't stand up.
DC was back to his old self within 48 hours. He is doing great now.
I am not that familiar with the Lantus as DC has only been on it for a week.
There is hope and this board is great. The people are very helpful.
I'm very hopeful Austin will make it through just fine. I would keep him off the MD though. DC was on it a few years back and his BG was always sky rocketing even with the insulin.
 
Re: Austin had a severe hypo today

Just stopping by to send long-distance hugs and good thoughts for Austin's quick recovery.

Do not blame yourself. You are not a vet. You love your kitty and are doing your best!

We'll all wait for news.
 
Re: Austin had a severe hypo today

Once he is home, write dosing advice in your heading, so the dose helpers here can advise you how to proceed--The vet is obviously giving too high A DOSE!!--1.00 unit is the starting dose here, but please verify that with Libby, D, Sienne, or the other yfolks here ...
Hope Austin will be just fine--Seems like you may need a HUG!!!!
 
Re: Austin had a severe hypo today

Sending lots of healing vines to Austin. So glad that you found this board. It has saved many of our kitties from vet mistakes. Hope to hear a good report for Austin tomorrow. Good thing you got him off the dry, "diabetic diet"--probably the worst thing for a cat with diabetes! Try to get some sleep tonight. Tomorrow is another day.

Ella & Stu
 
Re: Austin had a severe hypo today

i'm so sorry austin hypo'd. sending white light and positive thoughts...
please come back tomorrow to tell us how he is.
(((hugs)))
 
Re: Austin had a severe hypo today

Yay! He's out of the woods from the hypo and I'm meeting with the vet and picking him up in an hour. I'm at work now so can't post much, but just wanted to let you all know he's doing well. Will update later.
 
Re: Austin had a severe hypo today

This is wonderful news! Glad I opened this condo first!! Hope all is well..I know you are happy to have your boy home!
 
Re: Austin had a severe hypo today

Home and happy!

I'll try to start from the beginning of today and hope it make sense...

Rang the vet at 0800 and 1200 and was told all was fine. I rang again at 1530 to confirm $ (eek!) and was told again he was fine.

Appointment with the vet at 1640, who advised Austin ate a bit throughout the day and his BG level got up to about 18 and all was going well. They fed him about 1500 and gave him 3 units of Lantus = uh oh :sad: The Lantus saw another hypo come on, where his levels dropped to 2. Thank god he was at the vets for it. So, more glucose and checking.

When I picked him up at 1640 his levels were at 5.6 and had dropped again for the last 2 readings.

The vets advice was not to give any more insulin just yet and to monitor his levels closely until close of business tomorrow. He wanted me to take Austin back again for another BG curve tomorrow but, thinking of the $ and personal attention he could get at home instead, I've taken the day off work and from tonight am checking his levels every hour.

As for food, we came to a compromise: I'll keep feeding him the Hills Prescription m/d WET ONLY for now, at least twice a day, if he doesn't insist on also giving him dry food. A win-win there. :-D
 
Re: Austin had a severe hypo today

(sorry, need to post in 2 parts again for some reason)

A timeline of events might describe his levels best:

1500 - 3 units of Lantus - hypo of 2. 5 units glucose given at vets.
1630'ish - 5.6.
1730 - nibbled some Hills m/d wet.
1800 - 15.7
1900 - 18.1
2000 - 19.4

I'll get another 2 readings at least in tonight and will continue to test hourly tomorrow until about 1600, when the vet is happy for me to email him the readings and he'll advise our next step from there.

I'm so happy with the vet we saw today; he didn't discredit anything I said and was willing to listen to me, he's in favour of home testing, and is happy to take Austin on as a patient. :-D
 
I'm so glad your baby is home.
Please post often, as you will get plenty of advise and support and help from this board. I'm sure you will be advised to start him over at a lesser dose.
Enjoy your Austin being home, and post your numbers when you can.
 
I truly worry about your vet's knowledge, seriously.

Do NOT give so much insulin; I have no idea why your vet would repeat such a dose.
That vet food is not good, but I suppose the vet has to push what the vet sells.
You would do better with low carb foods from Binky's list posted earlier. The food your vet is pushing is 14%carbs, and you really should try to stay below 10% or less.

I personally would not follow the advice from your vet. Listen, yes; follow, no.
I would start on a dose of 1u and test to see how that dose goes. For all you know, even 1u may be too much! Certainly 3u and 2.5u are WAY too much. You are fortunate to have a tough kitty who is recovering from these hypos.

YOU are the boss of your cat, NOT the vet. YOU pay the vet for a service, YOU decide ultimately what to do, NOT the vet. There are plenty of things that you can't do like dental and Xray and ultrasound, but home testing and feeding are in your control, as is the dose you give to your cat.

Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

To convert your home test numbers to what most others here recognize:
1500 - 3 units of Lantus - hypo of 2. 5 units glucose given at vets.
1630'ish - 5.6. 100
1730 - nibbled some Hills m/d wet.
1800 - 15.7 283
1900 - 18.1 326
2000 - 19.4 349

Here is the link to the food listings. You can look up a few that are low carb and inform your vet the carb % and that you will be feeding the lower carb foods. Ask your vet for alternate suggestions that will be of a carb level of 10% or less.
Another site with important food info:
http://www.catinfo.org/
 
Thanks Gayle. I was a bit surprised myself that the vet went with 3 units. When we start back with his insulin, I'd personally like to start back at the beginning i.e 1/2 unit?

I've checked out Janet and Binky's food lists and, other than Hills and Royal Canin, nothing else is available here.
 
Of course you can start at 1/2unit twice a day because if it's not enough, you will see it in the numbers.
Remember that with Lantus, you need to stay on your dose for 5 to 7 days so the shed is filled. You need to give it all a chance to settle; changing dose frequently is not good, so just ride it out if the numbers don't seem to be coming down. Below is from the protocol.

"General" Guidelines:

--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).

--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).

--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.

--- Try to go from 0.25u to 0.1u before stopping insulin completely.


The protocol for increases is pretty easy to follow since you are home testing, just be sure to track all the numbers - look at my spreadsheets to see how I am tracking BG for Shadoe and Oliver.
You will see that I put both numbers for each test. Being in Canada, my mmol/L number like 11.4 so my vet can understand my sheet, and also the mg/dL number like 205 which is used on this site.
BG Conversion Calculator
 
I'm so glad Austin is home.

I am very surprised that your vet would return to a dose that caused hypo, as well. When a kitty here is that much over their dose, once the crisis is past, we typically skip the next dose in order to allow the Lantus that is in storage (i.e., the depot or shed) to drain a little. And we adjust the dose. If you want to start back at 0.5u, that's fine. It may be a little low but if so, we'll work toward getting Austin back to an optimal dose.

What I would suggest is that you get a spreadsheet started. This will allow you to keep track of Austin's numbers and to share that information with us. There is a template in the Tech Center that converts international numbers to the BG test numbers we use in the U.S. (or one of our Canadian members may be able to direct you to it). Most of us are less familiar with the international system (sorry!).

As for food, you're not compelled to listen to your vet. Once I explained to my vet that I could feed Gabby a lower carb, higher quality food (i.e., more muscle meat vs. by-products) for far less of a cost, she stopped pushing the Hill's M/D. Frankly, if you tell your vet that Austin won't eat the stuff, what's he going to say?
 
Very glad to hear Austin is home...

Please take all the advice you get here with an open mind - the people here are very knowledgeable and have probably spent more time learning about feline diabetes than your vet. They know what they are talking about!

Hope Austin continues to do well at home for you - can't wait to see how he does on a reduced dose.
 
Wow, glad Austin is okay! Cannot believe the vet gave him such a dose after him hypo'ing so badly... :shock: I second (third? fourth?) looking at the food list link- the food there gives you plenty of options for most price ranges. For what you pay for the prescription food that is NOT really very good quality, you can get a premium brand like Wellness or Evo.
 
So happy Austin is home :mrgreen: hope he continues to do well sounds like your vet does not know too much about FD but then again the vets I work for do not either so I would listen to the advice you are getting here this group of people are wonderful and will help guide you to help you and your cat :YMHUG: :YMHUG: :YMHUG:
 
Glad to hear Austin is home and you can make better dosing decisions. Sounds like your vet is taking some serious risks with your kitty's life that I wouldn't want someone else taking with my sugar kitty. I hope you are able to find some better food in your area!
 
wow this was scary! I'm so glad your Austin is home, safe and sound.

I would not go with the 3U dose either. You've been getting lots of good advice and it sounds like Austin is on the road to recovery!

YAY!

Hugs~

Caryl, Alex & Jackson
 
Very glad to hear he's home and okay.

I think I've heard that once a cat has had a hypo event they can be more sensitive to it and could drop again, so it's VERY good that you'll be home testing, as well as reducing his dose. It will take a little time for the insulin already in his system to diminish.

Once you have him stable again you can work on reducing the dry food in his diet. But for now, it's great that he's home and that you have a vet that will work with you.

Hugs to you and Austin both!!
 
You can start a new condo everyday& post his numbers there--
I really hope you follow the advice of the people here & not your vet--If a dose of medicine made you sick, would you take it again??
Doesnt make sense does it?? And the food you are feeding is high in carbs, so listen
Just keep posting here & what Sienne, Gayle & the others have said is correct--We all came here after our cats were dx'd & listened & learned here--Welcome to lantus land.
 
I'm so happy Austin is home.
Here are the links to the spreadsheet template that converts the numbers. It is the one I use also.
The first link is the instructions and the second is the spreadsheet template.
Hope it helps.

https://docs.google.com/present/view?id ... 27ftzbf3gr
http://docs.google.com/templates?hl=en&q=world-us

You will need to sign into google before you can use the template. Set up an account if you don't already have one.
It will be saved automatically each time you use it.
 
What a roller coaster... I'd start over, too. Having a high BG for a while isn't nearly as harmful as a hypo.

Where are you and Austin located?
 
Argh! My computer just froze and I lost my post. Here's the abbreviated version:

Levels since coming home last night:
1800 - 283
1900 - 326
2000 - 349
2100 - 358
2200 - 398
0800 - 538
0930 - 535
1100 - 526

Lantus last given approx. 1500 yesterday, 3 units, by the vet.

Food has been m/d wet only.

Austin seems to have recovered well, though his back legs seem weaker than before.

Gayle: thanks for the BG converter!

dodgingwrenches: Queensland, Australia.

Spreadsheet: when this has all passed and settled down, I'll definately be using the link to start one. Is it ok if I keep posting in here till then, though? I don't think my brain can handle having something new thrown at it at the moment. :oops:

Everyone: THANK YOU for your support!!
 
I will jump in and say:

When I came here, my kitty was getting badly overdosed on the vet's advice. I nearly lost him.

Then I found this website, and these wonderful strangers started talking to me. I found another vet, and we lowered Kitty's dose, and his life was saved.

Today, my boy is "off the juice" - diet regulated. No shots.

You have experienced, knowledgeable voices here. You are in the right place.

Hugs.
 
It's absolutely fine to keep all of your numbers here. I would cut and paste your numbers as you get them into your current post so everything is in one place.

A note on conventions that we use. The blood glucose test that you get before you give a shot in the morning, is you AMBG (AM Blood Glucose) and in the evening, PMBG. If you test 2 hours after your shot, that's your +2, six afters your shot = +6, etc. until you get to your next shot and the clock starts again. Because we're all in different time zones, using the actual time that you're shooting makes it hard to understand where you may be in the cycle.

Just another suggestion, if you are in Queensland, you have one of the preeminent feline diabetes researchers in your home town. Jacquie Rand, DVM has published a great deal of research on feline diabetes and developed the protocol that we use here. She is the Director of the Center for Companion and Animal Health at University of Queensland. At the very least, they could recommend a vet who is much more knowledgeable with respect to feline diabetes management.
 
Here's a red herring question that just popped in to my head, in 2 parts.

1) how long should it take for all the Lantus to be outof Austin's system?

2) (assuming the Lantus is all out of him) HIs levels are currentlywhat they were ON the Lantus, so what's the point?
 
It's not that you want all of the Lantus out of Austin's system -- that would mean starting over. Take a look at the stick about the Lantus depot or shed. Lantus is a type of medication that is called a "depot" drug. What this means is that there is a pool of Lantus that is stored under the skin. This pool acts as a storage shed (hence our referring to it as a "shed.") This Lantus-in-storage allows for overlap between doses and is why Lantus is a much gentler insulin than the other, shorter acting types of insulin. In other words, you don't generally see fast drops in BG levels or spikes up when Lantus is wearing off.

When you change a dose, it also means it effects the shed. When you increase a dose, it can take up to a few days for the shed to fill to the level to which the dose has been increased. If a dose is reduced, the next cycle may reflect the shed still being a bit over filled.

As I mentioned earlier, dropping the dose back to 0.5u may not be enough. I would give the dose a chance to settle and if it looks like you need to increase Austin's dose a little more quickly than we would ordinarily suggest, it will be OK to fast-track Austin. Given what he's been through, what you may be seeing is a big bounce from the low numbers. It can take up to 72 hours for a bounce to clear.
 
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