Cat had 2 seizures today, need advice

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suwannee79

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My little man George, a 10 year old orange tabby, was diagnosed at the beginning of February and we have had a rocky road getting him regulated!

He was started on 3 units of PZI once a day, this lasted for about two weeks and then he went into ketoacidosis. We had to take him to a different vet for that treatment and that vet switched him to 3 units of Humulin N twice a day. At this point we started feeding him Purina DM dry food.

We had to go out of town the first weekend in March and boarded him at the second vet's office, when I picked him up two days later he seemed fine but after two days at home seemed sick. Turns out the vet's office hadn't refrigerated his insulin for at least one day and we started wondering if he'd received his shots at all as he had ketones in his system again. The vet treated him for free and kept George at his office for another two days to treat the ketones and get him regulated, he also upped the insulin dose to 4 units of Humulin N twice a day.

At this point he still was running a little high but seemed to be doing ok. On March 22nd George had all the symptoms of really high blood sugar so we took him to the vet and his glucose was at 600! Luckily there were no ketones but he was dehydrated and had lost weight, the vet kept him through the day to get his levels down. At this point we had gone back to the original vet and they switched him back to PZI but changed the dosage to 3 units twice a day (made me wish I'd asked the second vet why he didn't try this before switching insulin!) We took him back the next day (March 23rd) and his glucose was still over 300 so they upped the PZI to 4.5 units twice a day. Because George needed to gain weight back we started feeding him Royal Canin Recovery wet food, George had always preferred dry food but seemed to love this stuff.

On March 28th I took George back to the vet and his glucose was still over 300 so they raised his dosage again to 5 units of PZI twice a day. I continued feeding George the RC Recovery and as he seemed to be ok with wet food started trying different brands to see if I could get him off dry food completely. He really liked the B.F.F. line of wet food so on April 1st I began feeding him 2 5.5 oz cans of B.F.F. each day and continued the 5 units of PZI twice a day.

This past Thursday, April 12th, I took George in for a glucose curve as he'd been on the B.F.F. for almost two weeks and I wanted to see how it was working with his insulin - I dropped him off just after 7am and received a call just after 2pm telling me he was ready to come home. He was supposed to have eaten at 11:30am and received his insulin at 12pm but they said he hadn't eaten and his levels were at 200 so they didn't give him the insulin. When I got home I discovered the food and insulin I'd taken to the vet's office hadn't been touched. I was mad because they obviously didn't try to feed him his normal food and by not giving him his insulin didn't that defeat the point of taking him in for the curve? The office was open til 8pm so they could have kept him for another 5 hours at least to see how he would have handled the insulin.

So that brings me to 3am this morning (April 14th) - my husband and I heard a sound on the stairs and discovered George having a seizure. My husband held him steady and afterwards George seemed fine. He hadn't shown any symptoms of hypoglycemia and after the seizure ate his remaining 1/2 can of food like nothing had even happened. We took him in to the vet at 10:30am and the vet said he'd had a hypoglycemic seizure and that three hours after receiving insulin is when it would start working - he had been given insulin at 12am and had the seizure just after 3am so that seemed in line with what she was saying. She said to continue on with his routine as normal but to keep an eye out for hypo symptoms.

When we got home from the vet we fed George and at 12:20pm gave him his 5 units of PZI - 3 hours later he had another seizure. He had been asleep prior to the seizure so we hadn't seen any hypo symptoms. The vet's office had just closed so I called another vet we'd seen and really liked on her cell phone. She asked if they'd checked his blood sugar when we'd taken in him this morning and they hadn't - I can't believe I forgot to have them check but more importantly I can't believe they didn't automatically check it when I said he'd had a seizure and they knew it was because he'd been hypo. I was also pissed off because this was the whole reason I took him on Thursday - when he was healthy - so they could see if his dosage was too high now that he was off dry food. The vet I spoke with on the phone wants me to try home testing as we hadn't been up to this point, she told me not to give him insulin tonight and she's going to get back to me tomorrow to let me know which type of meter I should get.

So if you're still with me I'm wondering if there's any chance this diet has him producing his own insulin again or is the dosage probably just too high now? Also, I've read about home testing and I think I'm going to try the ear method, my guy is a little fussy though so I'm wondering if anyone has any tips for calming down fussy cats?

Thanks so much and hopefully this all made sense!
 
Wow. Well, my opinion is that the dose has been too high since day one. No matter what sort of numbers the vet sees at diagnosis, a logical starting dose is never 3 units, nor is it correct to only tell you to shoot once a day. PZI doesn't last 24 hours in any cat. At least the 2nd vet realized twice a day was correct, but switching to Humulin was not a good move. Humulin works better on dogs than cats. Cats metabolize insulin twice as fast, and Humulin won't last long enough on a cat. It's also a quick acting insulin so it would cause steep drops in BG quickly.

Too much insulin, contrary to what might seem logical, can also cause high BG numbers. Dosing a cat with that much insulin can cause their body to react by instinctively producing glucose and dumping it into their system in order to ward off hypoglycemia. "Logic" would tell you to up the dose because the numbers are still high. All that does is continue the cycle. BG goes too low, liver dumps sugar to push it up, you test after that happens, you see high numbers, so you up again. Eventually you would overwhelm the cat's system, and he couldn't produce enough glucose to counter the drop in BG. And then you can get hypoglycemia, which is sounds like is what has happened not once, but twice.

I'm not convinced, by what you have said, that the vets are doing a very "good" curve when you leave him there. If they were, they would see the steep drops which are pushing his BG too low. It also sounds like you are not currently checking his BG levels at home?

OK, there are two things I would recommend you start immediately.
1 - buy a human glucometer and some test strips. You can get a meter for less than $10, made by Relion, at Walmart. They also sell test strips which come in 20, 50, and 100 packs. Last time I bought them, 50 strips was about $20. If you can test his BG at home, you'll never have to bring him in to the vet again to have a curve done. You can test him any time you want yourselves at home. If you are concerned about how to go about testing at home, don't worry about it. We can "show" you. We all do it. There's YouTube videos of it.

2- Decrease his dosage right away. A cat who has had two hypo seizures in a couple of days is being given way too much insulin. Most cats start at 1unit, twice day (BID) if not lower than that. You might worry that his numbers will be higher on a lower dose. And they might be on a short-term basis. But, high numbers won't kill a kitty quickly. Hypo's will. A seizure is one step away from a hypoglycemic coma and that can be fatal.

Keep feeding the canned food. Ideally, you want to feed all canned, all low-carb food. I am not sure what the carbs are like in the RCC, but I will look it up. Carbohydrates are a no-no for a diabetic. A diet that contains less than 10% calories from carbs is appropriate, and there are dozens of affordable easily found varieties sitting on the grocery store shelves. Many of us use Fancy Feast classic flavors, Friskees Pates style, even Special Kitty from Wal-mart. There are other higher-end foods that are ideal from places like Petco or Petsmart too. We have "lists" that can be found here:
http://binkyspage.tripod.com/canfood.html
Look them over and pay attention to the "% kcal from carbs" column and look for 7% or less. There's lots of them.

Please let us know how George is doing, and please lower that dose asap,
Carl
 
suwannee:

I am so sorry to read what you and George have been going through. Sounds like you really need to find a competent vet that understands feline diabetes, so you might want to post your location and ask if anyone has any suggestions for a good vet, nearby.

Other than that, do listen to the veterans on these boards. They are so very helpful with things you can be doing to keep vet visits and costs down, and regulate George more accurately, at home.

Good luck to you and George!
 
All I can say is wow, what horrible vets.

As has been said, there are a couple things to do right away.
1. Drop that dose to 1unit twice a day, 12 hours apart. I can't believe the dosing advice you received.
2. Pick up a meter for testing your cat's BG at home. Do not get any of the Free Style meters.
3. Pick up KETOSTIX to test his urine at home for ketones.
4. Feed only low carb wet canned food. Fancy feast and Friskies pates are the type most people feed.

Most cats never need 3units of insulin, and to start a cat at that dose is dangerous. Also, cats have metabolism that requires all insulin to be given twice a day. Cats usually should start at a dose like .5u or 1u.

Many cats are diet controlled so by changing the foods, your cat's insulin needs may have dropped right off.
Because you are hoping that your cat will need insulin for only a short time, how would you know if he no longer needs insulin if you are not testing at home. Humans test themselves before shots, so why would cats be any less important?

The KETOSTIX are important as it seems that some cats are more ketone prone, so by testing daily, you can catch any ketones starting up and clear the problem quickly.

I hope your cat recovers well from his seizures. I hope you are looking for another vet because the first two don't seem to be very good.
 
As for doing home BG testing on a fussy cat, my Pumbaa is a total wiggle butt and only like to be held on his terms. What do I do? I bribe him with high quality high protein foods treats, as in a bowl of sardines packed in water (no salt), in front of his face while I do the testing. He still wiggles and sometimes puts up a fuss, but having that bowl of sardines in front of his face truly makes a huge difference! I use the rice sock, warmed in the microwave for 20 seconds, and make sure I have extra test strips at my fingertips in case he wiggles and the blood doesn't wick correctly on the test strip I already have in the unit.

Oh, I use the Relion Micro, and found that I have 2 minutes from the time I put the test strip all the way in until I finally get that drop of blood into the strip. You can get the Relion Micro at Walmart for about $9, and 100 test strips $36.00 or $.36 per strip.
 
Thanks for the replies! Looks like I'll be getting the Relion glucometer tomorrow since that seems to be popular here. As far as the rice sock, is it just a sock filled with rice and then heated in the microwave? And as far as the testing, from what I've gathered you hold the warmed up item on the inside edge of the cat's ear and then get the reading from the vein along the outer edge? I'll check out the YouTube videos before I try this and I'm sure there's articles on here I need to look at.

A friend at work recommended a cat only vet clinic that's about 7 miles from my house so I'll be calling them this week to set up an appointment. I checked out their website and they have an entire section on feline diabetes and they say they can help teach you how to do at home glucose testing as well as your own curves so they do seem a lot more informed than my current clinic. It's kind of scary, I had no idea the current doctors were doing such a bad job, they've been so nice and caring but I guess in reality that only gets you so far!

George seems to be doing fine since the seizures, he's been eating and adventuring in the our backyard like normal but now I'm nervous about everything he does :sad: He really does seem ok but now I'm unsure of when to give him insulin again. I skipped his 12am dose and would normally give him a dose at 12pm but I guess I'll hold off as I can't get the meter til after noon. I'm a little hesitant to adjust his dosage but now I'm scared to give him the full five units of PZI, anyone have advice of how they started adjusting dosages?

In regard to the B.F.F. cat food (http://www.bestfriendsfoods.com/index.html), I don't see it on the Binky's list but it's BPA and grain free, however, they don't list calories, it just says feed 1oz per pound of body weight so I've been giving him a 5.5oz can twice a day and I give him half prior to his insulin and half a few hours later so he doesn't go without food for almost 12 hours. I'm still confused about how to read percentages, here's what his current favorite flavors have:

Tuna and Chicken Chuckles, Tuna and Pumpkin Valentine, Tuna and Chicken 4 EVA, Tuna and Salmon Soulmates:
Crude Protein (min) 12%
Crude Fat (min) 2%
Crude Fiber (max) 0.2%
Moisture (max) 83%
Ash (max) 2%
Taurine (min) 0.05%
Calcium (max) 0.25%
Phosphorus (max) 0.20%
Magnesium (max) 0.024%

It says the food is prepared in human food grade facilities prepared to AAFCO nutritional levels, not sure what that means but I hope it's a good thing. I've tried giving him Wellness and EVO wet foods and he won't touch them, the B.F.F. wet foods are the only ones he'll eat so far.

I wish now that I'd found this board sooner, so many things I would have done differently but I guess hind sight really is 20/20, all I can do now is learn what's on here and help my little guy! We have a second cat which can make monitoring water intake and litter harder but at least now we know preventative measures to take with her so hopefully she doesn't end up in the same situation!! Thanks again for the replies!!
 
All of the BFF varieties contain fish (tuna in particular). Too much fish in the diet is not too good of a thing - lots of mercury (tuna fish get OLD... older fish = more mercury) and some cats get fish addicted. Most cats LOVE Fancy Feast. I don't know what they put in it but I've never had a cat who didn't like it. Merricks is another high quality food.

Also - WOW that is way too high of an insulin dose. Those seizures were likely hypoglycemia induced and to be frank with you, you are VERY lucky those vets did not kill your cat. PLEASE drop the dose down to .5 or 1u twice a day and start hometesting ASAP. You can go up slowly and safely from that dose.

You can buy Ketostix at any human pharmacy to test his urine for ketones.

You will have so much more control over your kitty's diabetes and you can make sure he is being treated SAFELY. I just can't believe vets would give out such dangerous advice like that. :cry:
 
suwannee79 said:
As far as the rice sock, is it just a sock filled with rice and then heated in the microwave?
Click to expand...

A small sock or, if your're crafty, a little cotton square bag (kind of like those catnip square pillows you see at stores) works. Fill with uncooked rice (regular type, not inststant/quick cooking or boil-in-bag-type) or uncooked oatmeal or dried beans/peas. A 1/4 cup or so is enough but use less or more depending on the size of your sock or bag. Knot the sock closed or sew bag closed. I suggest cutting off extra sock material off so it doesn't get in the way of testing. Heat in microwave until toasty warm. Try 10 seconds and adjust time as needed. The sock/bag needs to be really really warm but no so hot that you burn your hand or your cat's ear in the 30 seconds or so that is needed to warm up the ear.


And as far as the testing, from what I've gathered you hold the warmed up item on the inside edge of the cat's ear and then get the reading from the vein along the outer edge? I'll check out the YouTube videos before I try this and I'm sure there's articles on here I need to look at.
Click to expand...

Here the hometesting tip page: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287

Most people warm up the outside edge of the ear. You're not poking the vein itself, just the space between the vein and the edge of the ear.


In regard to the B.F.F. cat food (http://www.bestfriendsfoods.com/index.html), I don't see it on the Binky's list but it's BPA and grain free, however, they don't list calories, it just says feed 1oz per pound of body weight so I've been giving him a 5.5oz can twice a day and I give him half prior to his insulin and half a few hours later so he doesn't go without food for almost 12 hours. I'm still confused about how to read percentages, here's what his current favorite flavors have:

Tuna and Chicken Chuckles, Tuna and Pumpkin Valentine, Tuna and Chicken 4 EVA, Tuna and Salmon Soulmates
Click to expand...


The problem with BFF is that it is all seafood-based. Some types of fish may contain mercury, tuna in particular, and some cats get addicted to eating fish and will flat our refuse to eat anything else. The phosphorus content of seafood can be a little hard on the kidneys. Seafood-based foods should be limited to once in awhile treats or meals.

Try to get your cat to get meat based foods. The company that makes BFF also makes Weruva which has many meat based varieites and also Soulistic which has a few meat based varieties in gelee (jelly) in addition to a bunch of seafodo-based varieties. But... many of the Weruva canned varietes are in gravy and/or contain rice and starches which may affect a diabetic cat's blood glucose level. The comapny does claim that their canned foods are low in carbs for a diabetic but some FDMB members have reported increased blood glucose levels. I only fed the Mack and Jack (fish in jelly) and Paw Lickin Chicken (slices of chicken in gravy) to my diabetic cat. Weruva also has the Cats In The Kitchen pouches which are all in gravy and may also affect blood glucose levels.

Besides Binky's charts, there is also the Pet Food Nutritional Values list, Dr. Lynne's Wet Food list, and the list of low carb gluten free Fancy Feast

On Binky's charts, stick with foods that have a number 10 or less in the carbs colum. On the Pet Food Nutritional Values Chart, look at the %kcal from carbs column and choose foods that have a number 10 or less.

The nutritional values on any pet food package are useless :-Q They only tell you that maximumor minimum guaranteed value. Binky's chart takes as fed values obtaned from pet food manufacturers and, after some calculations, the exact nutritional content is put on the chart. The food FAQ page has more in depth info about this: http://binkyspage.tripod.com/foodfaq.html
 
Just did my first at home test, that was nerve-wracking but George, other than being squirmy, seemed fine :razz:

His reading came back at 313 - I fed him a little bit about an hour ago and he finished eating 30 minutes ago. I haven't given him insulin since yesterday at 12pm as he had his seizure at 3pm, now I'm not sure what do about his insulin. His normal shot times are 12pm and 12am (my husband and I work evening shifts) so I don't know if I should give him a shot at 12a and if so how much? I know everyone to reply so far has said to just do .5 to 1 unit but as we were giving him 5 units of PZI (which I guess was overdosing) 1 seems so small in comparison.

Going to try and set up an appointment for the cat only vet clinic on Tuesday but I'm not sure what to do until then :shock:
 
now that you learned to test, test him again every 2-3 hours up until shot time, and test before shot time.

Chances are he will be above 200 and yes give insulin - as you don't want a DKA situation to happen.

and yes, starting over at a small dose .5 or 1 unit is the way to go. You can always increase insulin over time based on home testing numbers. But yes, while this looks like a tiny dose compared to 5 units, it is a safe dose. Remember you also changed his food, which alters the bg levels and now is the time to be safe not sorry.

that's my 2 cents. ;-)
 
When you are feeding the bad foods, 5u may be an OK dose... there was one cat who was giving around 20u and feeding dry food, but once the food was changed, the cat came tumbling down to around 1u dose.

Another lady on the board had not yet started insulin, but had high BG numbers.... changed the food and now the cat has numbers in the 80s so he may not even need any insulin at all.

Food makes a tremendous difference, so yes, that .5u may seem small, but you don't want to take a chance of giving too much and causing more seizures. It's much better to start low and work your way up in dose as it's needed.

You can always give more insulin but you can't take back too much.
 
Welcome! And breathe ;-)

What the above said. To be safe, only give 0.5 - 1.0 Units of insulin if he is high enough (200 or higher) at shot time

Since he has had seizures at least twice that you know, caution in giving insulin is highly recommended. You can't get it out once its in!
 
I haven't seen this first-hand, but others have reported, and I have read many times, that after a hypo episode, kitties will be more sensitive to insulin. So if you do give a shot tonight, a tiny one is a great idea. It might sound like such a small amount (.5 to 1.0) but some cats I have seen here never got more insulin than that per shot, and went OTJ.

Hilary is right also, test him a couple times prior to that, and before giving a shot, post the numbers here and someone will hopefully be around to take a look and help if you have any questions...

Carl
 
Checked his levels again at 9:25pm and they were at 327 - feeding him his dinner right now and will check again at 12:15am prior to giving him some insulin, I think I'll do 1 unit over .5 since his levels are raised right now.

Going to try and get in at the cat only clinic at 7a to try and get a second opinion on what the prior vets were doing, curious what they'll say!

Oh and quick question, as far as his feedings I've been giving him 1/2 of a 5.5 oz can 30 minutes before his insulin and then giving him the rest of the can a few hours later so he doesn't go almost 12 hours without eating - is this ok or should I be giving him the whole can prior to giving him insulin? Thanks!

Update: Checked his BG at 12:19am and it was 320 so I gave him 1 unit of PZI, will check his BG again in a couple hours to see how it's working
 
Most of us feed small meals throughout the day. I feed Scooter 1/4 of a 3oz can (Fancy Feast) every 2 hours or so, because he is a hoover and would gorge himself and puke if I fed him any more at once :lol: But no food 2-3 hours before shot time, so your preshot number is not food inflated.

Try to get a test at +2 (2 hrs after shot). If the number is a bit lower than the preshot number, chances are you are going to have an active cycle.

For example, let's say his preshot is 300, and you test at +2 and get 290. That isn't much of a drop so chances are he wouldn't drop much more that cycle. However if you got a 200, he may drop further in the cycle and it would be a good idea to test more. It's not 100% reliable, but a useful tip anyway :-D
 
I used to feed BFF--all the flavors in Aspic are low carb and ok for diabetics, but avoid the BFF flavors with gravy because they contain a large amount of potato starch: http://www.bestfriendsfoods.com/aboutfood.html. Potato starch can be tolerated by diabetics if the content if low enough, but the starch content in this food is too high for a diabetic. Again, as others have mentioned this food is fine to feed one or two days a week, but it's not a good idea to feed fish for every meal for several reasons. Cats get addicted to it, it's a very common allergen and they build up an intolerance to it over time, and it has high mercury levels.

Here's a site that has cat food nutrition charts--you can feed anything under 10% carbs. Also check out the grain free versions of fancy feast as well: http://felinediabetes.com/diabetic-cat-diets.htm. Here's a more current food list with premium foods if you want to go that route: https://docs.google.com/file/d/0B8Uu8g1u8Su9YTgxNGE1MDItM2MyMC00Y2Y3LWI4ODMtMzhkYTkxOGM4NThk/edit. I feed Bandit a combination of the lower carb Merricks, and Fancy Feast a couple times a week. Bandit also eats 4 times a day, because it's best to feed diabetics in smaller, more frequent meals. Also, it's the minimum amount of times I can feed him that keeps him from begging for food all the time. :smile:

If you aren't going to be home to feed, you can freeze food and leave it out, or just add some water. Bandit tries to eat the frozen food, so I have an auto feeder that I use to release it at his meal time when I'm not home.

The change to low carb food without lowering the dose definitely caused the hypo situation. Many cats will drop 100-300 points just by removing the dry food. Most cats on a low carb, canned diet do not need much more than 1u of insulin. 1u was the highest Bandit's dose ever got (he's in remission now and no longer needs insulin). 1u is also the usual starting dose for cats, regardless of type of insulin. I'm very sorry you had to go through all this, but hopefully your new vet will get you on track. Don't be afraid to get advice here, also--this site is a wonderful fount of information about feline diabetes.
 
Thanks for the response Julia and Bandit! I'll probably have to keep just feeding BFF til this weekend when I can really go check out the various wet foods in the store.

I am a little concerned about one thing: I took George to a cat only clinic this morning to get a second opinion and while I was there we did a glucose check and he was at 216, the vet thinks he may be on track for eventually producing his own insulin again. The doctor also said we should drop him down to 1 unit twice a day while we figure out what's going on with him and she wants me to do an at home curve in the next week. She also said she doesn't give insulin when the BG is 225 or less - as I was supposed to feed him and give him insulin within an hour after the appt. I asked if I should hold off on giving insulin but she said the trip and eating would probably cause him to spike a little so it was ok to give insulin, however, she said when in doubt skip the shot since it's better to be too high than too low. Well I got home from the appt. and he didn't want to eat much which is odd for him. When it came time for his shot I decided not to give it to him as he hadn't eaten much and I didn't want to risk him going too low. I tried feeding him again a few hours later and he still didn't want to eat much, I did another BG check and he was at 323. He seemed ok and I had to leave for work so I left some food out and am hoping that maybe he's still just pissed about the trip to the vet. I'm going to monitor him tonight and do some more BG tests but is it odd for a diabetic cat to get fussy about food every now and then?
 
suwannee79 said:
...I'm going to monitor him tonight and do some more BG tests but is it odd for a diabetic cat to get fussy about food every now and then?
Click to expand...

Inappetance happens - its one of the reasons we encourage home testing - you can't tell by looking if the cat has eaten!

Causes can include: stress (ex vet trip), food changes by manufacturer, other illness (pancreatitis is somewhat common; hepatic lipidosis if a cat doesn't eat enough or at all for 3 days, inflammatory bowel disease, the kitty 'cold', and so on.

We generally have new folk use 200 as a "no shoot' number, which may be lowered as you get the data to show how your cat handles insulin. Use what is most comfortable and what works best for your cat.
 
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