Cat sitter gave too much insulin; out of the woods now?

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grapey

grapey

Member Since 2012
I think my cat is fine now, but I wanted to double-check. Here's the story: While we were gone over Thanksgiving, the cat sitter accidentally gave Lily 4 units of insulin (lantus) instead of 1.5. This happened Wed evening, Thurs morn, Thurs eve, and Friday morn. By that point she'd called me, and I decided Lily should get *no* shot Friday night and then back to 1.5 units Sat morning (today).

The sitter said Lily never acted like she was having a hypoglycemic episode--no lethargy, etc. She was jumping on the cat tree, eating (possibly more than normal--to compensate for the low blood glucose?), drinking. So I'm not sure if Lily ever went hypoglycemic or not. But, in the past, when she's dipped very low--even into the 40s on the alphatrak--she doesn't have hypoglycemic symptoms. Our vet says she's very good at knowing when to eat to bring her blood glucose back up.

We're home now, and I checked her blood glucose on the Relion--it was 342, about 10 hours post-shot. I gave 1.5 u and an hour later she was at 310. She's eating, drinking, jumping, trotting, and acting normal

Am I out of the woods here? I want to know if I should keep worrying. I plan to call the vet Monday to run all this by her doc. (We go to an internal medicine specialist.) But as long as she's acting fine now and her numbers are reasonable, are we OK? For background information, Lily also has kidney disease, which seems to be under control with kidney food (it's a fine line with the food/insulin).

(That was a rough call to get the day after Thanksgiving, when we were 400 miles away. :(
 
The Lantus depot of a higher dose can last 4-6 cycles (2-3 days) longer but will diminish over time. If you kitty has high carb dry food available, that may have helped her.

Next time you go away, try loading a sample syringe with colored liquid, to show the dose for the petsitter. I am glad Lily was OK!
 
When I had a sitter I marked several syringes with a red line and told the sitter not to fill beyond it. So glad your kitty is ok! :cat:
 
Yes, she did have high carb dry, actually. Kind of a long story, but I guess it was good to have in this case.

My father in law usually takes care of the cats when we are gone, but he couldn't this time. He does a good job. I don't think I'll trust anybody else!
 
I agree, the higher carb food probably leveled things out for her. Also, sometimes it can take a bit of time of chronic overdosing before the cat will exhibit physical symptoms of hypoglycemia. Their livers will dump glucose into their bloodstream if they have low blood sugar (or their body thinks they have low blood sugar), and then they will have continuously high numbers for several days. Over the years, Bandit only ever gave me a hypoglycemic number maybe 3 or 4 times, but each of those times he never exhibited any physical symptoms.

What stage is Lily's kidney disease at? There are quite a few commercial foods that are good for both diabetes and kidney disease, for the earlier stages. The prescription diets aren't recommended anymore unless the cat is in late stage kidney disease, because they do cause muscle wasting. This happened to my cat, Gabby, who had stage 2 CKD. The vet put her on the prescription kidney food (whway over a period of months. After doing a bit of research on my own about CKD, I switched her to an all canned, high quality protein, low phosphorus diet. She did which she hated), and she literally wasted away on that diet, and regained most of her muscle and weight very quickly. In the two years I had left with her, her CKD never progressed any further (she passed away from stomach cancer, not the CKD). Recently, Bandit was also diagnosed with Stage 1 CKD (adding it to our ever growing list--we now have diabetes, IBD, chronic pancreatitis, myelofibrosis, and CKD that we deal with and he's still somehow doing really well--not sure which of his nine lives he's on at this point), and he's also on a low carb, low phosphorus diet.

The high carb, low protein kidney diet is the opposite of what a diabetic cat should be eating, so unless Lily is fairly advanced in the progression of her kidney disease, a low carb, low phosphorus diet might help things quite a bit in regards to the diabetes. Also, cats with kidney disease really shouldn't eat dry food unless they refuse canned food despite all efforts; it's really important they stay as hydrated as possible and dry food causes chronic dehydration problems (even if you see your cat drinking a lot). I'd be happy to suggest some foods for you to try if you're interested!
 
We had to strike a delicate balance with her food. Right now she eats a combo of 2/3 Hill's kidney care, wet, and 1/3 fancy feast pate, wet. She's in the beginning stages of kidney disease after a horrible bout of pancreatitis/DKA about a year ago. Last thing I heard, her creatinine and BUN are right on the end of normal, thank God. Her food combo, plus the 1.5 units twice a day, seems to be working well, so I'm not going to mess with it. But you're right--the low protein kidney diet is the opposite of what a diabetic cat needs! We only give her dry occasionally, as a treat.

It's not ideal, but we've had a rough year. Long story short, I spent 11 weeks total in the hospital, so we've done the best we can.
 
@grapey , I completely understand your situation, as Bandit just had a severe case of pancreatitis in March and that also caused his creatinine to elevate to the high end of normal, and he was also diagnosed with early stage CKD at that time. I understand your hesitance to change things after settling into a routine, but her CKD is definitely not advanced enought to necessitate the kidney diet, which is 27% carbs (canned). That food will impede your treatment of her diabetes, as it will be hard to get her diabetes controlled and you're not likely to reach remission on that food (if that is your goal). But also, the main reason you don't want to feed that food to an early stage cat is that it will cause muscle wasting when fed long term, and diabetic cats with uncontrolled diabetes are already prone to muscle weakness due to neuropathy. I would strongly recommend that you change the diet, because there are foods out there that can meet all of her medical needs, and they're going to be less expensive than the prescription food. For the diabetes, you need less than 10% carbs. For the CKD, you need high quality protein and less than 250 mg/100 kcal. For the pancreatitis (if it's a chronic situation), also feeding low-moderate fat could help with recurring inflammation. I would also cut out all the dry, even as a treat, because that is also too high in carbs. There are freeze dried treats like these from Origen that you can give instead of the grocery brand dry treats. There's a food chart here that gives you the nutritional breakdown of a lot of commerical cat foods that you can refer to when choosing a diet.

Cats with kidney disease should also not eat Fancy Feast if they can help it; it's extremely high in phosphorus and contains byproducts (lower quality protein source). You're not even going to get the low phosphorus benefits of a low protein diet if you're combining it with Fancy Feast, only the drawbacks of hard to control diabetes and muscle wasting.

Of course, the first rule of cats with CKD is that you must feed them what they will eat--so if the Fancy Feast is on board to stimulate her appetite, there are other foods and tricks you can use to try and get her into a different food, like Fortiflora, or mixing a slightly lower phosphorus alternative (like Sheba) with something that has dramatically low phosphorus (like Weruva).

Bandit has very similar nutritional needs to Lily (diabetes, chronic pancreatitis, early CKD), and he eats Weruva and Wellness core canned flavors: Weruva Paw Lickin' Chicken, Steak Frites, Cats in the Kitchen Chicken Frickasee, Cats in the kitchen Funk in the Trunk, and Wellness Core Turkey, Chicken, and Liver and Beef & Venision. All of these foods are less than 10% carbs to meet his diabetic needs, are less than 250 mg/100 kcal of phosphorus, and are high quality proteins (largely muscle meat, no byproducts). These particular flavors also have low to moderate fat, which helps handle his chronic pancreatitis and GI issues. I like to switch up the flavors a lot to keep him interested in multiple things in case of another pancreatitis attack where his appetite wanes, but you can experiment with ones that she likes the most or check out the food chart to try out some different foods with similar protein/carb/fat contents. We also had a rough year this year, with Bandit's myelofibrosis diagnosis on top of everything else, and while he still has to go see an internal medicine specialist every few weeks at Cornell for testing, he has completely done a 180 since March and is back to his normal, active self, is off all meds, and his diabetes is in remission again.

One thing to note, and this is very important, is that if you change her diet, it's very likely her insulin need will lower, so make sure you're testing frequently and adjusting the dose as needed.
 
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Is there a list out there with the phosphorous levels of different foods? Similar to the list of carb content?
 
Sorry for bringing back this thread--I can't seem to find the nutritional info for either of the feline kidney foods (Hill's k/d or Royal Canin renal support E). I've scoured that chart but I don't see them. Can someone help?

Thank you!

According to that chart, the FF I've been giving my cat has been really high in phosphorous :( I'm going to switch to a type of FF with much less phosphorous, though a bit more carbs (not too bad). (It's FF grilled vs. classic.)

Edit: OK, I found the prescription food at the bottom of the chart. But I don't see the new Royal Canin renal support E (which I guess replaces the renal lp).
 
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