Dangerously low numbers-- do I bring him in to emergency?

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Anna K

Member Since 2014
Please take a look at Bruno's chart (ALPHA TRAK):

https://docs.google.com/spreadsheet/ccc ... sp=sharing

He is very low right now (it's +5 right now). He is eating a HC food.

He ate at +4.5. After that his blood sugar went down not up. It's now +5, he is eating more. Do I bring him in to the vet right now? Or keep feeding and testing as long as he is eating?

At what point do I rub honey on his gums?
 
Re: Dangerously low numbers-- do I bring him in to emergency

Anna, hold tight. I'm trying to find someone for you.

Is Bruno showing any hypo symptoms?
 
Re: Dangerously low numbers-- do I bring him in to emergency

OK, it went from 52 to 47 back to 52 while eating. I think some of this could just be glucometer. I don't think he's really going up or down. I am feeding him more now.

His appetite has been generally low these days. It's due to small cell lymphoma. That is a story for another thread.

For a second I thought he was shivering, then he stopped. He is very curious, wants to go outside and is more active than usual. Not disoriented, not falling, not walking into things. Looks pretty healthy. He's getting mad at my testing, has energy.
 
Re: Dangerously low numbers-- do I bring him in to emergency

You're doing fine....feed a little high carb food and retest in about 20 minutes

I need a minute to look at your spreadsheet since you didn't say how low the number was
 
Re: Dangerously low numbers-- do I bring him in to emergency

52 @ +4.5
47 @ +5
52 @ +5:15
49 @5:30

This was all while eating HC food.

Alpha Trak! 49 is like 19 for the rest of you.

I'm going to rub honey on his gums now.
 
Re: Dangerously low numbers-- do I bring him in to emergency

Looks like we crossposted.

Don't feed him a LOT...just a teaspoon or 2 at a time. If his numbers drop under 80 again, you're not going to want him to not eat because he's full. Keep feeding just a little and testing until he's at least in the 90's

You can also add a few drops of honey to a teaspoon of food to add an extra "boost"

If he gets into the higher 90's, stop feeding, but don't stop testing! We want to make sure he stays up after the high carb food wears off. You need to keep testing until it's been at least 2 hours since you've given him any food.

He's also earned a reduction tonight, so tonight's dose should only be .5
 
Re: Dangerously low numbers-- do I bring him in to emergency

If those numbers have not come up I suggest a few drops of glucose/honey/syrup, and then re-test in 10 - 12 mins.

Honey/glucose acts very quickly but also wears off fairly soon (in my cat, after about half an hour). And if it doesn't lift the BG high enough you may need to repeat this action.

Higher carb food kicks in a bit more slowly but lasts longer.

How is your cat now?
 
Re: Dangerously low numbers-- do I bring him in to emergency

Just gave honey and tested 5 minutes later. It's 61 now. So they are coming up but remember this is alpha trak, it's like 31 for the rest of you.

Next step: More food or nothing? Vet or no vet?
 
Re: Dangerously low numbers-- do I bring him in to emergency

We are taking him to the vet. With honey.
 
Re: Dangerously low numbers-- do I bring him in to emergency

If he doesn't come up further you may need to take him to the vet, so be prepared for that possibility.
Is there someone who can go with you?
How long is the journey?
Would be good to take honey/syrup with you in case you need to administer en route.

This may not be necessary but do be prepared.
If you do go to vet, get someone to phone ahead for you.
 
Re: Dangerously low numbers-- do I bring him in to emergency

Yep, keep feeding until he's at least in the 90's

You don't need to take him to the vet unless he really drops a lot and starts showing hypo symptoms but almost 100% of the time, if you catch the low number, you can handle this at home with just lots of tests and high carb food, but you have to be comfortable with handling it at home
 
Re: Dangerously low numbers-- do I bring him in to emergency

That makes 2 of us Elizabeth!

Let us know how he is Anna, and safe travels.
 
Re: Dangerously low numbers-- do I bring him in to emergency

Chris & China said:
...You don't need to take him to the vet unless he really drops a lot and starts showing hypo symptoms
Click to expand...
Be aware that some cats show symptoms early on, some late on, and some not until hypo is quite advanced.

Chris & China said:
..almost 100% of the time, if you catch the low number, you can handle this at home with just lots of tests and high carb food, but you have to be comfortable with handling it at home
Click to expand...

Yes indeed.
 
Re: Dangerously low numbers-- do I bring him in to emergency

88 at the vet (Alpha Trak). The good news: We live in an urban area (San Francisco) with a great emergency vet, 5 minutes from home, and they checked him immediately. Better news: they didn't charge us.

I might have been too hasty taking him there, and yes I could have kept his BG up myself, but I'm new at this and would rather be too cautious than not cautious enough.

I will keep testing today.

This was all my fault. He has not been eating well. He did not have enough breakfast. I just wasn't sure how much "enough" was and I gave him a shot anyhow. If he does not eat much dinner I'm not giving him any shot.

This is part of a bigger problem, small cell lymphoma. We have a vet appointment on Wednesday about that. The last few days he's been eating maybe half as much as he should. Yes I know the list of things to entice a cat to eat but ultimately, he's not going to get ravenous on his own. The vet says, it's kind of like feeling carsick all the time. He just feels yukky. This would be bad on its own but combined with diabetes it's very hard to know the insulin dosing.

PS I can't get a photo avatar but I really want y'all to see how cute he is. This is Bruno: http://instagram.com/p/K2cLLct1ax/
 
Re: Dangerously low numbers-- do I bring him in to emergency

Awww! He looks like my Cobb! I love orange tabby cats!!

Hasty perhaps, but safe. You'd rather be safe than sorry!

Glad his numbers came up! :smile:
 
Re: Dangerously low numbers-- do I bring him in to emergency

To get your avatar, go to http://www.shrinkpictures.com/create-avatar/ ....or if it's on Photobucket, I think you can resize it there

It can't be bigger than 90 x 90 pixels

Then you just go to the User Control Panel, "Profile", "Edit Avatar"

I love the orange ones too! Until just recently, I've always had an orange kitty as part of my family

Now that the emergency is over, please go ahead and remove the 911...don't want anyone else having a heart attack (which we do when we see that...LOL)
 
Re: Dangerously low numbers-- do I bring him in to emergency

120 now (alpha trak. That's like 90 for the rest of you).

Chris, I'm a photographer and this makes me feel dumb. I can use photoshop to shrink it to 90x90 and I still get the message that it's too big. Shrinkpictures just gives me black squares, weird. Oh well. I'll just describe him: Totally adorable orange tabby devon rex. Sweetest cat in the world.
 
Re: Dangerously low numbers-- do I bring him in to emergency

Well that's strange!

If it's 90x90 it should be allowing it. I've gotten the "too big" message, but I don't ever remember seeing black squares :?

Of course he's adorable! We only have adorable cats here...and he's EXTRA sweet! :-D

Good to see he's up into safe numbers now. Don't be surprised if he bounces high tonight
 
Re: Dangerously low numbers-- do I bring him in to emergency

I'm just scared to give him insulin at all. He eats so little. He just ate 1/2 small can of Tiki cat sardines. If he eats another 1/2 can at shot time then I will give him a shot. Otherwise, no shot.
 
Re: Dangerously low numbers-- do I bring him in to emergency

Anna K said:
I might have been too hasty taking him there, and yes I could have kept his BG up myself, but I'm new at this and would rather be too cautious than not cautious enough.
Click to expand...
I absolutely think you did the right thing. Those numbers were awfully low and could have gotten lower much more quickly. You kept your head on straight, gave honey, and headed to the vet. Perfect. You're right, you might have been able to bring the numbers up on your own, but it's not worth the risk.

Sometimes people get complacent about low numbers here because it is not common for a cat on Lantus following the Tight Regulation Protocol to have an actual symptomatic hypo. However, that assumes that the cat has been strictly following Tight Regulation from the beginning AND that there are no other extenuating circumstances. Steroids, lymphoma, and lack of appetite are extenuating circumstances, IMHO, as well as being too new to really have a ton of data on your cat. It's much better to be safe than sorry so you did exactly the right thing.

This is part of a bigger problem, small cell lymphoma. We have a vet appointment on Wednesday about that. The last few days he's been eating maybe half as much as he should. Yes I know the list of things to entice a cat to eat but ultimately, he's not going to get ravenous on his own. The vet says, it's kind of like feeling carsick all the time. He just feels yukky. This would be bad on its own but combined with diabetes it's very hard to know the insulin dosing.
Click to expand...
I'm sorry about the lymphoma. You're right, that does throw an extra wrench into insulin dosing. Cancer can really make some cats' insulin needs drop dramatically. If there may be cancer in the picture, then you might have to throw protocol out the window and play extra cautious. You can look at my KK's spreadsheet - I'm a huge advocate of the tight regulation protocol, but for KK, it was not safe.

For sure, after hitting numbers this low, you do not need to give the same 0.75 unit dose again. I would reduce the dose at least to 0.5 units, but I also think you should watch his eating and maybe not even give that much. See if he bounces and let that be a clue. He might not bounce, and if he doesn't, then you might want to be even more conservative.

Thanks, Elizabeth, for pointing out the AlphaTrak to the other posters.
 
Re: Dangerously low numbers-- do I bring him in to emergency

He ate a normal dinner but I'm still reducing from .75 to .25. I got so scared, and I can't stay up all night to check him.

When he was on Chlorambucil + Prednisone he had a good appetite and gained weight. The lymphoma was managed and this is the usual protocol. It can be very successful.

But prednisone caused diabetes. Now he is on Chlorambucil + Budesonide which is less effective for lymphoma.

Perhaps I should put him back on the Prednisone. This would mean the diabetes would get worse and I'll have to raise the insulin. I read somewhere else on this forum "cancer before diabetes" or something like that. It's a difficult puzzle. I want him to eat and gain weight.

THANK YOU Chris and Libby and Suzanne!!

Anna
 
Re: Dangerously low numbers-- do I bring him in to emergency

Yes Anna!!

If the cat has another disease that can cause more trouble than the diabetes, you treat that disease first and just use more insulin if necessary, so if his lymphoma is best treated with a steroid, that's what you should use.

We have cats with IBD here a lot too that require steroids..you just have to increase the insulin to try to control the blood glucose.

Hope Bruno does well on the reduced dose!
 
Re: Dangerously low numbers-- do I bring him in to emergency

Thanks again Chris, as usual you are always helpful and right on.

If there's one thing I learned from this forum (and other internet sites) it's that all cats need to be on a wet food low carb diet. If I'd known this 13 years ago I might have avoided IBD, lymphoma, and diabetes all together. At least my little 3 year old cat is now on the good food like Bruno and hopefully she will never face all these problems. Now I am going around telling everyone about what's in cat food!
 
Re: Dangerously low numbers-- do I bring him in to emergency

I am relieved that things are OK, Anna.

You did amazingly well.
You kept a clear head and did what needed to be done.
For what it's worth, I think you did the right thing in going to the vet to get your cat checked. You hadn't experienced low numbers before and you have the additional complication of your kitty's lymphoma.
(Incidentally, I had meant to post more here yesterday, but kept losing my internet connection, hence some very short posts!)

It used to be said much more on this forum, but is said less these days (as we have got more experienced with hometesting and dealing with low numbers): Hypos can kill.
They can also cause brain damage. I remember an incredibly poignant post by a guy some years back thanking people for their help during a hypo situation because his cat had only been blinded, but was still alive. (Sometimes blindness is temporary and comes back as the cat recovers from the low glucose, but in this case the cat hadn't recovered it's sight.)

Another thing that used to be said more but is now seldom heard is that 'absence of symptoms does not mean absence of hypo'. A cat can be fine one minute and seizuring in the next.

I know dangerous hypos on this forum are a rarity. But I've been around long enough here to know that they can sometimes happen.

Elizabeth

PS. Anna, I am so sorry to hear about your kitty's lymphoma. And I hope you still have a long, long, long time together.
Best wishes to you.
 
Re: Dangerously low numbers-- do I bring him in to emergency

Elizabeth and Bertie said:
I am relieved that things are OK, Anna.

You did amazingly well.
You kept a clear head and did what needed to be done.
For what it's worth, I think you did the right thing in going to the vet to get your cat checked. You hadn't experienced low numbers before and you have the additional complication of your kitty's lymphoma.
(Incidentally, I had meant to post more here yesterday, but kept losing my internet connection, hence some very short posts!)

It used to be said much more on this forum, but is said less these days (as we have got more experienced with hometesting and dealing with low numbers): Hypos can kill.
They can also cause brain damage. I remember an incredibly poignant post by a guy some years back thanking people for their help during a hypo situation because his cat had only been blinded, but was still alive. (Sometimes blindness is temporary and comes back as the cat recovers from the low glucose, but in this case the cat hadn't recovered it's sight.)

Another thing that used to be said more but is now seldom heard is that 'absence of symptoms does not mean absence of hypo'. A cat can be fine one minute and seizuring in the next.

I know dangerous hypos on this forum are a rarity. But I've been around long enough here to know that they can sometimes happen.

Elizabeth

PS. Anna, I am so sorry to hear about your kitty's lymphoma. And I hope you still have a long, long, long time together.
Best wishes to you.
Click to expand...

i agree 110% with everything elizabeth said above. i was actually holding my breath as i was reading through this thread. whew! i'm glad all is well!
elizabeth, thank you for realizing the extent of what was going on here as well as reminding the other responders about anna's use of the alphatrak meter!

anna, you did an awesome job with Bruno. your gut instinct to take him to the vet was absolutely correct. it's better to be safe than sorry. sometimes i think we become complacent about low numbers and they aren't always given the respect they deserve. i'm another one who has been around long enough to know dangerous hypos can and do happen from time to time.

i'm so sorry to hear about bruno's lymphoma. there are others here who have had kitties with lymphoma. libby is one. there are also others who will offer a helping hand.

oops! i almost forgot... welcome to the board! i don't know that i've ever posted in one of your threads before.

~ jill
 
Re: Dangerously low numbers-- do I bring him in to emergency

I can't thank you all enough. Better appetite this morning I'm going to keep him on .5 for now.

One more thing I can say as a public service announcement to the other newbies.

If you are new, there are two approaches described on this forum. One is the "tight regulation" protocol (described here) and there is the "start low and go slow" approach described here.

It took me a week to really understand the difference!

In a nutshell: Tight regulation is more likely to get your cat into remission. The Start Low and Go Slow approach ("relaxed") is much more conservative and keeps your cat on smaller doses. If I were on this relaxed approach I would not have had the scare I had yesterday. I would have yellow numbers and not all blue and green. But I wanted him to go in remission. I wanted more green numbers. And to do that you have to be SUPER VIGILANT. Don't do what I did. Don't shoot if the cat didn't eat much breakfast. Be hyper vigilant.

It took me a while to figure out the difference between the two protocols, but basically: one is for getting your cat out of remission, the other is for keeping the numbers low enough to avoid ketones and to avoid sugar spilling into the liver and kidneys. It's more managing, not curing.

If you are new, and super eager like I am, remember that the tight regulation means TIGHT. You have to check often. I work from home so I can do this, but I still can't do it enough, and I had a big scare. LUCKY I was home. I could easily have f---ed this up. If you are not able to check all day long, it's OK, do the "start low and go slow" approach. Your baby might have higher numbers this way, and may never go into remission. But if you aren't home at nadir time, you don't want a hypo event.

I am trying to get Bruno into remission. My vet has high hopes for this. Bruno responded well to his diet change and small amounts of insulin. He has not been diabetic long. I think I can do this, but I am going to have to be super careful. We have the added complication of a low appetite. I hope someone can learn from my experience.
 
Re: Dangerously low numbers-- do I bring him in to emergency

Anna and Bruno,

Fantastic job you did yesterday to keep Bruno safe. An emergency visit to the vet was absolutely the right call and so glad to see you took him and Bruno is ok.

Yes, you are correct that the TR (tight regulation) protocol used here is very aggressive. You really need to be on top of things if you decide to follow the TR protocol.

SLGS is a good approach too. Cats have gone off insulin and become strictly diet controlled on this protocol also.

Just remember that Bruno has already earned one dose reduction. Perhaps, he will earn another one in the future.

Keep him safe. You and Bruno are part of our FDMB family now, and we worry about family. {{{{{Hugs}}}}}
 
Re: Dangerously low numbers-- do I bring him in to emergency

definitely get a + 2 today and see where he is at. Lantus is a depot insulin and the higher dose could still be in his system
 
Re: Dangerously low numbers-- do I bring him in to emergency

Hi Libby,

Curious-- what happened with little KK? Is his diabetes managed? Is he eating?

Again, my Bruno did not want breakfast. When I do not give insulin or give very little, he never gets super high BG though. Stays in the high blue numbers.

All he wants is tuna. :(

Anna
 
Re: Dangerously low numbers-- do I bring him in to emergency

Whenever there is another medical condition, and treatment of that affects glucose control, you adjust the insulin.

If prednisone worked better at controlling the lymphoma, adjust your insulin around that. It'll keep him eating. You may wind up shooting much higher doses of insulin, so you may want to look at getting Lantus from a Canadian or international pharmacy. Sometimes duration can be affected by the pred, so you may want to consider using Levemir in that situation.
 
Re: Dangerously low numbers-- do I bring him in to emergency

Anna K said:
...Again, my Bruno did not want breakfast. All he wants is tuna. :(

Anna
Click to expand...

Hi Anna,

Oh, I do so sympathise.
I had two kitties with cancer last year (both with intestinal cancer) and I know how hard it can be to get them to eat, and how heartbreaking it can be when they've turned their little noses up at the umpteenth can of food they've been offered. (One of mine only really wanted tuna too...)

I did find that Fortiflora was really helpful in tempting mine to eat (just a little sprinkle on food could sometimes be enough). And they would sometimes drink Whiskas (or similar) cat milk, or plain goat's milk, or milk for kittens, especially if warmed slightly, And I also added a pinch of taurine to their food to give them a bit of a boost. And I sneaked extra fat into their food to try to keep the weight on them.
They weren't diabetic, so I could also try other higher carb foods without having to be concerned about blood glucose levels.

I found too that raising the feeding dish helped enormously in encouraging them to eat.
And sometimes they would take a little food from my finger and then start to eat from the dish.

As they got sicker I started taking the food to them, wherever they were resting. And I made sure they had food and water very close by (and also a litter tray).

I know this is a hard road, Anna. But there is also something very special about being able to care for a companion animal in this way. It develops a very close bond, and the time shared takes on a very precious quality indeed.

Wishing you many happy days together,

(((Hugs))),

Eliz
 
Re: Dangerously low numbers-- do I bring him in to emergency

Thank you all for your kind words. I agree with both of you, BJM and Elizabeth.

Anna
 
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