BG extremely LOW- UPDATED

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Sue and Ruben

Member Since 2010
just got back from vacation and my cat looked lethargic. didn't come to the door as he usually does. did not purr when i picked him up. he is walking and alert but not his normal self. had a pet sitter. he is on 1.5 of lantus. i have a horrible feeling he was given 15 instead. took reading it was BG 20. gave him about .06 of karo and FF. next reading 15 min later and the meter says BG is too low to read. gave more karo. any further advice. he is resting but not acting odd..not falling down, seems alert but off.
 
Re: BG extremely LOW- NEED ADVICE

Give him a lot more karo.....even a tbsp if you have to ...how close is the closest ER? If you think your pet sitter gave him 15u, you need to get him to the ER immediately where they can get him on a glucose drip.
 
Re: BG extremely LOW- NEED ADVICE

the number is now 24. i gave him much more than a tablespoon already. i will give another tablespoon.
 
Re: BG extremely LOW- NEED ADVICE

Sue

Do you know how long it has been since he was given insulin? Lantus hypos can last up to 16 hours. Is there any chance she's given him too much insulin for more than one cycle? If so, the lantus depot can really gang up on numbers.

If you've given him tht much karo and he's still at 24, I would get him to the ER. Glucose starvation can impact the brain and you could see delayed neuro symptoms.
 
Re: BG extremely LOW- NEED ADVICE

Another vote for the ER --- 24 is much to low to be playing around with on your own IMHO. If your cat is early in the cycle and the lantus is still actively lowering BG you may not be able to keep him stable and rising without a glucose drip.
 
Re: BG extremely LOW- NEED ADVICE

Sue --

Please get him to the ER. If he got as much insulin as you suspect, he needs to be on an IV dextrose drip. You can't do this at home. Numbers will go up and down and a hypo of this kind on Lantus can go for 16 hours or more. Please get Ruben to the vet and keep rubbing Karo on his gums. I don't have a kneejerk reaction when it comes to low numbers. I would not tell you to scoop your cat and run if I did not think this is an emergency.
 
Re: BG extremely LOW- NEED ADVICE

Wonder if there's a way to contact the pet sitter to verify the dose... 15U would be half the syringe, right? :o
 
Re: BG extremely LOW- NEED ADVICE

hi guys
thanks for the support and advice. i took ruben the the ER (mass referral hospital) i didn't want to mess around with thisr. i wanted to give him the karo to try to stabilize him and see if i could get the numbers up. by the time i got to the vet, he was up to 38 but they kept him overnight, which was the right choice. by the time i left the ER at 3am, he was up to 114. i really don't know the dose the sitter gave. she was there for 3 shots. it seems odd that she would make a mistake so dramatically only on the last shot...and clearly he would not have survived three 15 unit shots. ...so i will have to find out what went wrong. other possibility is there is another underlying issue that is unrelated. i tend to doubt it. thank you all again for being there in a crisis with spot on advice. all of your comments were incredible helpful. i flew to the ER after the first few posting and when i realized that karo works well only for a short time and he needs to be monitored throughout the night. you guys rock. thanks a million. i plan to pick him up tomorrow and all will hopefully be fine.
 
Re: BG extremely LOW- NEED ADVICE

I'm glad you took him to the ER, and his BGs are up. Don't forget, sometimes, a cat that has gone through that low of a BG, may be extra sensitive to insulin for awhile. Hope all is well, today, when you pick him up. :YMHUG:
 
Re: BG extremely LOW- NEED ADVICE

Well done, Sue. You did the best for your little Ruben and even though it is terrible taking these guys to the ER (we have had to do it twice already in our first months), sometimes it's necessary. Hang in there and try to not worry too much. I know that's hard for me so I'm sure I'm not the only one. He is in good hands for the next few days. Try to get some rest in the meantime so that when he's back, you're relaxed and welcoming for the little dude. Charlie in Amsterdam is proud of you. :smile:
 
Re: BG extremely LOW- NEED ADVICE

I can't tell you how relieved I am that you took Ruben to the ER and he's OK. I kept watching for an update.

FWIW, I always suggest to people to set up a sample syringe with colored water. There are too many times when someone, not just a sitter, draws up the insulin and hasn't had a chance to squeeze out the excess, gets distracted, and shoots with too much insulin in the syringe.
 
Re: BG extremely LOW- NEED ADVICE

quick update: talked to the pet sitter and she definately did not give him 15 units. she has sat for me many times and is super responsible so i didn't think deep down that could be it but had no other way to justify the drop. This morning, his numbers are back in the 100's with the sugar IV but they can't seem to keep the numbers there. he keeps sinking back to low numbers. he is having a hard time staying consistent. now, they are taking blood and urine to see what else is going on as well as an ultrasound. doesn't sound like it is a reaction to too much insulin. very odd. never had this happen at this low a number and even when he did dip to 50 or so, he would rebound and maintain. fingers crossed it is not serious.
 
Re: BG extremely LOW- NEED ADVICE

Hope Ruben gets better soon! Praying for his bg to stay stable.
Take care Sue and keep us posted!
 
Re: BG extremely LOW- NEED ADVICE

If I may suggest, ask the pet sitter to come over and demonstrate for you the way she would normally draw up the dose, this may help you to see what she did. Of course, she may be super conscious about it and do it correctly, but hey you never know.

And FWIW, he is in the best place he needs to be right now and I hope that all goes well.
 
Re: BG extremely LOW- NEED ADVICE

Sue, thank you for the update. I'm glad Ruben is doing OK and paws crossed for further tests. Could you change the subject line of the first post since the crisis is over?
Liz
 
Re: BG extremely Low --UPDATE

thanks all for your support. will check in later with update. hope it is nothing serious. paws and fingers crossed.
 
Re: BG extremely LOW- NEED ADVICE

Sue:

If this was an overdose, even an inadvertent one, Lantus can do exactly what the vet is describing. It can take 16 or more hours for numbers to eventually stabilize.
 
quick update: still waiting on blood and urine results. he did have a seizure at 7am. thank goodness he was in the ER. vet seems to think his injections of 1.5 ml are now too high, even though i took a reading before i left on vacation (sunday) and it was in the 100's.
 
Wow! I am really sorry to read this. I am so glad you got home when you did and took him to the ER.

I will be thinking healing thoughts for Ruben today.
 
Thanks for keeping us updated Sue. We're all hoping for the best and sending healing thoughts to Ruben. I'm so glad he's at the hospital where they can give him the best care. You did well.

Melanie & Racci
 
We're pulling for you Ruben! When you get home, your mom is REALLY going to spoil you.
Hearing that you had a seizure breaks my heart a little bit.
Hang in there,
Charlie & family
 
thanks all---the many healing vines worked their magic. ruben is coming home today after 2 nights in the ICU. doing much better. first time in 4 years he has ever gotten to such a low level. the vets at the ER hospital say a diabetic cat should be in the 150-200 range, not the normal 50-100 range for a non-diabetic cat. i have tried to keep him in the blues and greens...aiming for 75 bg-100 bg overall. they say that is way too low. it goes against everything i have read here along with the advice of dr. lisa, whom i trust. can others weigh in on their experience on this issue or with a hypo situation and the follow-up (level maintenance) afterward. again, thanks for all the support.
 
I suspect the ER vets are basing their statements on cats who's caregivers do not home test. For those who don't home test, vet's rely on fructosamine tests and/or a curve done in the vet's office. If you look at the ranges on a fructosamine test, a fructosamine level below 250 (which translates to below a 120 BG level) is considered "prolonged hypoglycemia." We know that this isn't necessarily the case. If you averaged Ruben's home test data for 2 - 3 weeks and your average was 90, his fructosamine result would be below 250 and someone like the ER vet would be freaking out. The problem here is that the vet would not have the context of what the numbers actually are. I think the vet is basing his statement on fructosamine ranges which do not account for normal BG ranges.

FWIW, I had this same discussion with my vet recently. I also told her that it's for this reason that I don't consider a fructosasmine test useful when I'm home testing.
 
Hi Sienna
we didn't do a fructosasmine test and i told her i test several times a day (although my spreadsheet has not been kept up) ...still they want numbers in the upper 100's to 200's. i think that is too high.
the issue is when i am not here to test and i go away. that is when it gets scary.
sue
 
Hi Sue, I wonder if the ER Vets are basing their numbers on the animal or AlphaTrak meter which reads 30 or so points higher? Most of use the human meter?
 
I think Ann has a good point. But I also think Sienne's point is extremely important: vets don't realize how much we hometest.

The vet we had been using when Gracie was diagnosed had been our vet a very long time and she was great. BUT she said the same thing as the ER Vet and she also told me I didn't need to hometest....I could just adjust dose using glucose stix. She had never had a client willing to hometest. So when I took Gracie's SS into her, she was shocked at what cats actually do when they are not in her office getting a curve. When clients are just doing glucose stix, then she would have them keep the cat at +1, assuming it was just above renal threshold. But I showed her how Gracie could be at +3 (probably above 300) on a glucose stix but still be in the 40s because it takes a while to clear that glucose out of the urine. She did not get upset over low numbers because she knows Mike and me well. So I think that it is sort of a shock for them in many cases and they are not going to tell you to keep the cat lower than 150 because they can't be available all the time to help.....and so then you have a potential liability issue on top of everything else.

However, Sue, once a kitty has a hypo like this, they can be very insulin sensitive for a bit. I know you were going to cut his dose back from 1.5u but I'd be sure and take it down maybe more than .25u and then bring it back up if you need to.

I"m so glad he's ok....we were all worried!!
 
Sue

We're discussing dose.....what did they give him in the ER, what dose did they recommend, and what were the discharge instructions specifically?
 
Sorry if I confused you. My point wasn't that you had fructosamine results.

Most vets rely on a fructosamine test not just to diagnose FD but to gauge how well a cat's doing on a dose. The way the test is set up is that the anything below what would be a 120 on a glucometer is considered "prolonged hypoglycemia." As a result, if a vet sees BG test numbers that are in the normal range, they think in terms of a fructosamine test (i.e., below 120 is bad). With that kind of thinking, there's no way to know if a cat has been surfing in the 75 - 100 range or is swinging from 20s to 300. Because it's an average, you don't know.

I hope that makes more sense.
 
I had this same discussion with my vet when she said they like cats kept in the 200 range generally and don't expect people to test. When I asked her how she expected them to ever have a remission that way she had no answer, especially when I told her how many cats in our group had remissions on tight regulation. The topping to it all was when Racci had normal bg and no glucose leaking from her urine and was in great shape this last time. She had to admit that TR was working well.

Melanie & Racci
 
Hi All
Ruben is now home and doing fine. I have dropped his dose from 1.5 to 1/2 unit as per the vets instrux. Will test throughout and monitor and go from there. He has gotten to 1/2 unit before and i honestly thought he might be OTJ or close to it but he could not maintain that level for any stretch of time. will see how he does at his dosage and take it slow a day at a time. his thyroid levels were up so are going to run a T4 test to see what is happening and if it might be related to the drop. thanks again for all the input and feedback. extremely helpful and informative. best decision was to give him the Karo take him immediately to the ER. Even in the ER with sugar drip, he still crashed and had a seizure so it just shows, you can't mess with really low numbers even if the cat is not exhibiting truly hypo signs yet.
 
I am so glad to see this good update. Like many others here, I was anxious to hear news the next day.
I hope you can stick around and give us updates on Ruben and maybe we can help you get him OTJ. Wish he didn't have to be so dramatic about it though!

MJ
 
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