Bad Reaction to 1st Dose of Insulin?

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KittyCatJake

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Hi. My kitty Jake was diagnosed with diabetes a couple of days ago by a specialist. He was suspected to be diabetic for about a year prior with high blood glucose, but in house lab stuff showed other values as normal and no sugar in the urine. I took him to a specialist a few days ago and they tested him, found sugar in the urine, and prescribed .5 insulin. To add to this, Jake also has another major health issue going on at the moment, something in the nasal area causing facial swelling around the nose and has eye involvement (I think). He is booked for a CT and biopsies etc on Tuesday but I'm worried he won't survive the anaesthesia. It was thought by the vet that getting him started on insulin would help get him in better health for Tuesday. So, last night I gave him his first dose of insulin. I then wiped his nostrils with cotton wool soaked in warm salt water. About 20 minutes after his insulin dose he started breathing funny and making honking noises (no doubt at least partially related to his nose issues).....he also started licking his lips (as though he was nauseous) he didn't seem too happy....I should have tested him last night but resisted the urge because the vet told me not to do it or I would lose my mind with worry. I fed him brekky this morning (syringe fed ad) and he didn't seem as hungry as usual. I called the emergency vet to see if I should give him another dose this morning. When I described what had happened, they thought it unlikely it was related to the insulin and told me to keep going with it. So, I got it ready and when I went to give it to him I noticed he had vomited up his breakfast......I have never ever seen him vomit up food and he is almost 15. I called vet back and they told me not to give it to him. I ran a home test and he was 22.8.....last time I tested him at home he was about 18 (that was pre-diagnosis and a day before my regular vet cleared him for diabetes based on the other tests). I am so confused.....the amount prescribed is miniscule and I struggled for about 20 minutes last night trying to get it right and I'm pretty sure it was close to the right amount. Also, I put a tin of food out for him about an hour after he vomited and it seemed his appetite was back. I won't be able to speak to his specialist vet til Tuesday so would really appreciate thoughts on this. Thank you.
 
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First of all welcome to FDMB. I can only imagine how upsetting this all is for you.

For a reaction to start in 20 minutes would indeed be unusual unless of course Jake is sensitive to something in that particular type of insulin. That said, some insulin onsets much earlier than others but I still don't think it's likely the insulin would cause a reaction in 20 minutes but every cat is different. While 0.5u seems a minuscule dose of insulin, our cats are little creatures and usually don't need a lot of insulin so while that is a small dose, it's quite a common one.

I have a few questions for you.
Was the diagnosis of diabetes and prescription of insulin done solely on the basis of finding glucose in Jake's urine or were other blood tests run like a Fructosamine?
What type of insulin did the vet prescribe?
What meter are you using to test Jake? Human or pet meter?
Sounds like Jake will eat on his own? Why were you syringe feeding him A/D yesterday? Is the assist feeding necessary sometimes due to the nasal/facial issues?
Has Jake been tested for ketones?

For now, if I were you, I think I'd check Jake's BG periodically through the day. Take a test when Jake hasn't eaten for at least a couple of hours and then feed him and test again about 3 hours later to see if the BG has gone up or down or stayed basically the same. That will give you some information about whether his pancreas is putting out more insulin after he eats.

We have a very helpful spreadsheet available to track BG readings, insulin shots and it gives you a very visual picture of what Jake is up. If you are interested in setting one up, it will help us help you. The instructions for setting it up are HERE and THIS document explains the spreadsheet and how to use it.
 
Thx so much for your reply! Quick update - Jake got his second dose of insulin about 1 1/2 hours ago (skipped this morning's on vet advice). He seems to be doing quite well. He's laying in bed and I just laid beside him and I heard what sounded like the first proper genuine purr I've heard from him in awhile. He was 25 when I administered it. I'll check it before I go to sleep. I'm not going to be able to do it as much as I'd like (the checking) as the poor little guy is also getting eye drops 3xday, antibiotics morning and night (2 at night), insulin 2xday and being syringe fed. I'm not even sure I got any insulin in him tonight....the amount is so miniscule and it's so hard to make sure you get it right! He also needs sleep in between all that, as do I!
Re your questions, quite a few tests were done over about a year. I think first time it was high blood glucose, normal fructosamine. Next time, high blood glucose, highish fructosamine, next time, high blood glucose, normal fructosamine. He started to lose weight about 8 weeks ago, and had started sneezing not long after. I bought a test kit and tested him at home and his blood glucose was over 18.....took him back to vet, fructosamine was normal and there was no sugar or ketones (sp?) detected in urine. His sneezing has now developed into something quite serious (they're not sure what yet) and when I took him to see an internal medicine specialist last week she ran a lot of tests though I'm not sure what they all were. I didn't ask but assume they were thorough. She told me this time there was sugar in the urine and said given his increased drinking, weight loss etc, time to start him on insulin.
The insulin is lantus.
The device I am using is the accu-check proforma.
Jake is eating on his own a bit at the moment, but not nearly enough. He's very sick and has lost 1/2 kilo over the last month. He needs calories for sure. Hopefully the insulin is going to help with the weight loss.
Re the spreadsheet, hopefully one day soon whatever is going on with his nose will be fixed and I'll find the time to do that....sadly right now he is facing a far more serious issue, and one which has me fearing this may be the last weekend I have with him.
Leaving aside the diabetes.....they originally diagnosed a sinus infection, then a week later he'd developed an ulcer on one of his eyes, a week after that his forehead started swelling, about a week after that, the top of the bridge of the nose had swollen, and now he is swollen all down the side of his nose as well. It's terrifying. Fingers crossed for Jake! He's a serious sweetheart.
 
Wow... that is quite the history. Poor Jake! We will certainly keep our fingers crossed for both of you.

I can completely understand that you really don't want to be poking at Jake too much at this point in time given all the meds he's on for his nasal/facial issues not to mention just handling him around his head. Sounds like Jake has been borderline diabetic for awhile and now with his other health issues, it's become more pronounced needing some treatment. The insulin you are using is a gentle long lasting one and the dose the vet has recommended given the BG readings you have taken, seems a very reasonable conservative starting point.

I'm glad to hear this time there has been no unusual reaction post shot and I can just imagine how thrilled you were to hear Jake purring! Such a soothing and delightful sound!

Those small doses can be a pain but you'll get better at it with practice. Lantus has a very obvious medicinal smell and I used to do a quick sniff test after shots along with a light hand check of the fur for any wet areas to determine if the shot was successful or not. You likely did get some if not all the insulin in Jake so never give a second shot even if you think you've totally missed.

Do keep us posted. We adopt all the kitties and their humans who come visit/join us and I'm sending healing thoughts and prayers for Jake and (((hugs))) for you.:)
 
Have you tried feeding Jake prescription food Hills A/D or Purina CN? Both are foods you would get from your vet. They are for sick pets that need extra calories and nutrition. Some pets will eat it when no other foods seem to work. They also mix with water well to help with syringe feeding.
 
I just tested him (4 hours post injection) and he's pretty much the same as he was pre-injection....which means I messed up on the dose and perhaps accidentally gave him nothing. Now I have to wait til morning to try again.
Lisa and Witn.....Jake has been eating AD since Tuesday....thankfully he still likes it. I don't think we have Purina CN here in Australia.
Getting a blood sample to test has not been easy and has required multiple attempts causing Jake great stress. I will need to watch some youtube videos tomorrow to see if I can do it better....I'm using out ear area.
Thank u again for all ur help & support. It's much appreciated!
 
KittyCatJake said:
Leaving aside the diabetes.....they originally diagnosed a sinus infection, then a week later he'd developed an ulcer on one of his eyes, a week after that his forehead started swelling, about a week after that, the top of the bridge of the nose had swollen, and now he is swollen all down the side of his nose as well. It's terrifying. Fingers crossed for Jake! He's a serious sweetheart.
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I'm so sorry to hear about all the problems that Jake is having. I hope you keep us updated on the cause of Jake's problems with his face swelling. I really hope that he feels better soon. He's so fortunate to have a wonderful cat "parent" taking care of him.
 
Thank u again everyone!
Unfortunately not having any luck with the insulin. Gave him a shot this morning, tested 4 hours later and it was over 17, which is way too high....figured there was nothing in the needle again. Gave him a shot almost 3 hours ago, and this time I'm pretty sure I got at least the required amount, and his reading is 32, which is the highest I've ever seen it. Why did it go up instead of down with the insulin? That is really high?!!! What can I do??
 
Lantus is a depot insulin which means some of the insulin is used each cycle and a small portion is stored for ongoing coverage....like a carry over effect. For that reason, until you get the depot built up, you will not necessarily see how that dose is working for Jake. The depot takes a few cycles to build up and until then you won't see the full effect of that dose. It may be that Jake needs a higher dose and increasing systematically (every X number of cycles depending on dosing method being used) and incrementally by small amounts (0.25u) at a time ensures that you don't skip over the best dose.
You've had what you considered to be fur shots in the last couple of days so it's likely the depot has not filled yet. Patience is the key with diabetes. It's a marathon not a sprint.
 
Jake has had a terrible night unfortunately. Peed in bed (while he was sleeping I believe), wandering aimlessly this morning. Just tested him and he's still over 30.....arghhhh. He has never peed in bed before. I am very worried.
 
Do you have urine strips to test for ketones? Would be good to test for them with his sugars so high.
In case I missed it, are his eye drops a steroid? That may increase his sugars if so.

Eta: when does he see his vet again? Peeing in bed is definitely concerning. you may want to call them for advice.
 
I don't have urine strips unfortunately. The eye drops are antibiotic ones. His specialist vet isn't back in until tomorrow at which time he is booked to go in for ct scan. I may postpone the scan as I'm so worried he won't survive the anaesthesia, but also worried he won't survive without a proper diagnosis. He is still walking aimlessly. Just gave him his morning dose of insulin.....will have to go to work shortly and won't be able to check him til I get back.
 
Just checked him one hour post injection (before I left for work) and he is still upin the 30s. His readings were usually between 18-25 before I started the insulin. Can I buy test strip for ketones at a pharmacy or should I bring him into vet?
 
KittyCatJake said:
Just checked him one hour post injection (before I left for work) and he is still upin the 30s. His readings were usually between 18-25 before I started the insulin. Can I buy test strip for ketones at a pharmacy or should I bring him into vet?
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You can get ketostix or ketodiastix from any pharmacy
 
Thx for the info re ketostix! I'm an idiot....just got home and realised I didn't put the insulin back in the fridge this morning. Another trip to the vet.....arghhhhh. And freaking out.....Jake's tests are tomorrow and he isn't doing great today. Just tested him and he was at 20.....hadn't eaten for about 7 hours at that stage. Just called vet and told them I'd left it out (been almost 9 hours on counter) and they said it should be ok?
 
Thx so much! Please everyone, send positive thoughts to Jacob today. He is booked in for a CT scan and possible rhinoscopy, biopsies etc. He is quite weak and very skinny and I'm terrified about the anaesthesia. But there doesn't seem to be any choice....if he isn't diagnosed, he will almost certainly die and it seems the only way left that they can diagnose what is going on with him. It is being done in a specialist hospital. Hopefully I'm back on here with good news in about 12 hours.
 
KittyCatJake said:
Thx so much! Please everyone, send positive thoughts to Jacob today. He is booked in for a CT scan and possible rhinoscopy, biopsies etc. He is quite weak and very skinny and I'm terrified about the anaesthesia. But there doesn't seem to be any choice....if he isn't diagnosed, he will almost certainly die and it seems the only way left that they can diagnose what is going on with him. It is being done in a specialist hospital. Hopefully I'm back on here with good news in about 12 hours.
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Both of you will absolutely be in my thoughts.
 
Sending prayers and positive thoughts for Jacob
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and hugs for you:bighug::bighug::bighug::bighug:. Please do keep us posted.
 
Sitting in car waiting for call from vet. So scared I can barely breathe. Unfortunately not a sting or bite.....started with sneezing and started swelling few weeks later. Likely cancer or fungal infection. My big concern right now is that he survives today's procedures.
 
Very bad news. Jake has nasal cancer and it looks like it has penetrated the brain. They want to keep him overnight and do a blood transfusion and try to get his diabetes under control....sitting in parking lot waiting to hear back from them about the fees involved in doing that. Might be outside my budget as today alone has already cost about $4000.00. Arggghhhhhh.
 
Jake is spending the night in hospital. We should have biopsy results in a couple of days, but the news is not good. Definitely some form of nasal cancer and it is fairly advanced. Very peeved at my regular vet for missing what was really going on (he was treating what he told me was a sinus infection) as I started bringing him in about 6 weeks ago and at that stage I suspected diabetes (which he wrongly ruled out it seems) and Jake was sneezing. A week later Jake developed an eye ulcer and the vet told me it wasn't related to the sneezing, but it was.....the cancer has gotten into that eye. Feeling so sad right now. Fingers crossed I have him home tomorrow night and that he still has some quality time left on this earth.
 
I am sorry for everything Jake is going through and you as well. I have a Jake at home too. You are doing amazing things to be so thorough with his care. There are many people who may have given up at the first sign of any issue. Make kitty comfy. If he is in a critical state I wonder if a somewhat faster acting insulin would be easier to control his blood glucose levels. I'm using Lantus now but I started out on a shorter acting NPH. It's not great for the long haul, but I did appreciate the more immediate dose control. My sugar cat has a tumor as well. Cancer stinks.
Hugs to you and Jake both.
 
I'm so very sorry to hear the results. Keeping Jake and you in my thoughts and prayers. Fingers and paws all crossed here that you get to spend some more quality time with your boy!:bighug::bighug::bighug::bighug:
 
I'm so sorry to hear that Jake has cancer. If you had known sooner, it probably wouldn't have changed the prognosis. I lost a cat with the same symptoms five days before Jack was diagnosed with diabetes. My vet suspected that Wally had cancer, but I knew that I couldn't afford the treatment even if I could know for sure. The vet had said that treating nasal cancer would be extremely difficult and extremely expensive. So try not to have regrets, because you have been a loving friend and caregiver in every way, and you have done all that you could do. You even went as far as having the biopsy to be certain that you had no other options . He is fortunate to have you. You'll be in my thoughts. I'm so sorry.
 
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AliceMeowliss&Cassandra said:
I am sorry for everything Jake is going through and you as well. I have a Jake at home too. You are doing amazing things to be so thorough with his care. There are many people who may have given up at the first sign of any issue. Make kitty comfy. If he is in a critical state I wonder if a somewhat faster acting insulin would be easier to control his blood glucose levels. I'm using Lantus now but I started out on a shorter acting NPH. It's not great for the long haul, but I did appreciate the more immediate dose control. My sugar cat has a tumor as well. Cancer stinks.
Hugs to you and Jake both.
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Oh no, I'm so sorry you are also dealing with cancer.....it is just awful. The vet has put him on a dose of 1 unit now, instead of the 1/2 he was getting.....he was at over 30 when he left hospital tonight. Hopefully that dose helps get it under control.....part of the reason the vet says he has a poor prognosis with the cancer is because of the diabetes.
 
Got home a short while ago with Jake from hospital. The biopsy results came back and it is nasal lymphoma. He got some sort of chemo drug before he left hospital today and he's booked to see the oncologist Friday. I have to work Friday and am terrified I won't be able to get there with Jake. Jake's vet bills are now at about $7000 and that has wiped me out and then some, so I can't take Friday off if I want to keep paying his vet fees.....arghhhhh! And the vet said Monday was leaving it too late. Anyhow, re the diabetes.....she has doubled his dose to 1 unit....he was still 35 when he left the hospital tonight. She believes he has a poor prognosis and seems very very worried that the diabetes is going to become deadly on it's own. She thinks he has a very poor prognosis. I hope the oncologist is more positive. He's home tonight, weaker and skinnier than when he went in. Apparently there is a 30% chance he will respond to chemo, but she put his chances of survival below 10% because of his diabetes and the fact that the cancer has reached his brain. I can't believe he went from the vet considering him normal (he thought he might be pre-diabetes, but said he didn't have it yet) to a stage where she's worried about him dying in over a month. It's all so confusing! She's again told me not to test him over the next week.....I won't do it (much).....it really stresses him out when i prick at and then squeeze his ear, so I don't mind skipping it this week.....I will probably do i a couple of times if he looks like he's up to it. Right now he looks pretty miserable....I just have to hope against hope that now that they know what it is, they can treat it at least to the extent where he has a bit more quality time left. Time to do some research on nasal lymphoma.....I'm certainly not giving up yet! Thank you so much everyone for all the messages of support. I am sorry I can't reply to you all individually, but I didn't get back from the vet til late tonight and it's bed time (after I give Jake some more food)......and I still want to do some research before I go off to sleep. Please keep him in your thoughts....he needs all the help he can get right now. Hopefully my next post is a happier one.
 
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