DX 2/2011... almost lost him last night... thoughts?

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vampfaye

Member Since 2012
Hi,
My name is Lisa and I have two wonderful kitties. I've been a lurker for a while and never posted before. Sorry for not making myself known sooner...
My oldest, Magic, was diagnosed in Feb 2011 and is 11 years old. We have been successfully controlling his diabetes with Lantus at 4 units every 12 hours - 3am and 3pm. He's a 17 pounder and was 20 at diagnosis. I took him to the vet on Saturday and had a glowing report. His glucose test was 97 at 8 hours post injection. He was due for a booster shot so that was given during the visit as well. That's where the trouble began... We've had our first real hypoglycemic episode. Even at diagnosis, he wasn't hypoglycemic. He was actually at over 500 when he was first tested and dx'd.
He seemed ok when we got home from the vet Saturday and he slept for quite a while. I gave him his normal dose of Lantus at 3pm - right on time. He went back to sleep and I went back to normal life. Approximately, 7pm I found him lying on the kitchen floor but thought nothing of it as occasionally he likes to lay on the cool tile. Two hours later he was at the base of the steps, still seeming to be sleeping. I picked him up and he was hyper salivating. Within a couple of minutes he had a seizure. Being new to the area, I had to call a friend to find out where the pet ER was and by the time we got there it was close to an hour since the first observed seizure and he had two more while in my arms on the way to the ER. I assume he had at least one prior to my discovery of him.
He was post dictal when we got him checked in and they took him back immediately, gave him some valium and did a glucose check. He was <20. After starting an IV, running fluids and a dextrose bolus, he seemed to perk up and knew we were there. The ER wanted to keep him overnight, so my daughter and I said our goodbyes during which he gave me one of his head butts and I felt pretty hopeful that he was going to be ok - although I did sign a DNR in case he crashed during the night. (one of the hardest things I've ever done) I was instructed to be back at 8am to take him to my vet for further treatment options.
I got him to my vet this morning, with IV catheter still in place. His glucose check was 190 and she cleared him to come home with the promise of starting to do checks on him myself. (I had tried when he was first dx but was unsuccessful.) The IV was removed and I was directed to test him and call her about 3pm for further instructions. After getting him home, he ate a 1/3 can of fancy feast, which is a treat for him, and seemed tired but ok. At 3pm, I tested him and his glucose was at 151. I called the vet and she said do not give him any insulin unless his levels go over 200 and then to only give 3 units.
His behavior has been a bit off and he is cuddling but not purring. He has been hiding under the bed and when I woke a bit ago I had to dig him out from under there again. His level was 151 at 200a. I put him in his litter box and he urinated quite a bit. I offered food but he refused, so I opened a can of chicken and drained off a bit of water and added a few drops of karo syrup then fed him with a dropper. He seemed to perk up a tad and managed to jump into the bay window on his own, which is where he is right now. He has not had any insulin since his 3pm dose Sunday afternoon.
Here are my concerns... is it typical that he isn't sleeping with me on the bed like normal? Usually, he's all over me all night long. He's also not purring at all. I guess if he feels punky for a few days that he won't exhibit typical behaviors but the behaviors that are calming to him, like sleeping with me or purring when I barely touch him seem to be absent. When we got home he ate like he was absolutely starving, now I had to force feed him. Am I worrying for nothing? Should I just let him alone and monitor his glucose for a few days or should I be concerned? This guy has been with me through so much and he is my rock. (debilitating illness, comfort after many of my surgeries, devastating divorce and new relationship) I'm not ready to lose him. In the past, just thinking of losing him reduced me to tears. I've been crying a lot the last 24 hours and am exhausted myself. In fact, I was afraid that I wouldn't wake up for his 3am test.
What are any of your thoughts on this?
I'm worried sick and guess I just need some reassurance right now. nailbite_smile Any input will be appreciated.
Thanks,
Lisa - Akron Ohio

Magic aka Boo - born 5/15/2001 - Black Siamese mix
Roxy aka SpEd - born April 2007 - Siamese/Ragdoll mix
 
vampfaye said:
Hi,
...I took him to the vet on Saturday and had a glowing report. His glucose test was 97 at 8 hours post injection. He was due for a booster shot so that was given during the visit as well. That's where the trouble began... We've had our first real hypoglycemic episode.


Hello Lisa and Kitties! And a warm welcome to FDMB!

Gosh, Lisa, it sounds like you've been through a really tough time. But take heart, you will find a lot of advice and support and reassurance here. :smile:

OK, first off I suggest you take a really deep breath, and then another one... It'll make you feel a little better.

So, Magic was DX in Feb 2011 and is on Lantus, 3 units twice a day? (And when you say "booster shot" do you mean he gets something else in addition to that?)

Well, what leaps out at me from your post -if I've understood you correctly - is that Magic was given the "booster shot" when he was in normal blood glucose numbers (97 (or 5.3 outside of the US)). He didn't need that insulin shot.... :shock:

Following the hypo Magic will be more sensitive to insulin than is usual for him too, so a dose reduction will be needed, if indeed insulin is needed at all... (I take it that he's had no insulin since the hypo? As vet said not to shoot below 200?)

It sounds like you've starting hometesting. Well done! That will give you a lot of info about Magic's BG's and is an essential tool to keep him safe.

It is not unusual for cats to feel poorly after a hypo, and it may take a little while for Magic to feel like his old self. But try not to worry.

I'm NO expert, but I think an appropriate course of action could be to monitor Magic for a few days. And keep a check on his blood glucose levels. But if his appetite deteriorates further, or his behaviour deteriorates, then that could be a reason for a vet visit. But see what others have to say...

Is Magic eating at all now? And what food are you feeding him generally?

Best wishes,

Elizabeth in UK
 
Welcome Lisa!

I would urge you to set up a spreadsheet to track your numbers: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207. This is an incredibly helpful tool that allows you, your vet, and the experienced Lantus users here to see what's going with Magic.

I have a few questions for you to help figure out what to do with Magic--what kind of food(s) are you feeding him and how often are you testing his blood glucose levels? I'm asking because 3u is still a rather high dose if there are no secondary conditions other than the diabetes. The large majority of cats on a low carb, canned diet never need much more than 1u of insulin. Dose adjustments with Lantus should be made in .25u-.5u increments, depending on the daily nadir (lowest number of the cycle). This means that in order to truly understand how the insulin is affecting your cat, it's important to test at least 3 times a day --once before each shot, and a test in the middle of either (or both) cycle(s). Too much insulin can keep preshot blood glucose levels just as high as too little insulin, and numbers obtained by the vet at their office are going to be inflated due to stress. Both of these factors often lead to chronic overdosing by the vet, especially if you're not home testing frequently enough to confirm the dose of insulin is correct, as human diabetics do. Which is why it's absolutely fantastic you're home testing now! It's the only way to safely and effectively give insulin to your cat.

When the Lantus dosing protocol is followed (in .25u-.5u adjustments based off daily nadirs obtained via home testing), and the right diet is fed (low carb, canned with NO dry food offered), the large majority of cats go into remission and no longer need insulin.

We have a ton of tips and tricks to help with home testing, so don't hesitate to ask if you need help.
 
Welcome Lisa! I can definitely relate to your hypo experience. I came home at lunchtime to find my Buster face down on the floor, totally limp and twitching. Honey on the gums and off to ER! After a bit of dextrose, we got a kiss and a head butt and left him overnight. The next few days he was very low/sensitive to insulin. Buster didn't have any issues with eating and he seemed pretty normal in his behavior when we got him home. I imagine ECID (every cat is different) in these situations. Buster had been on insulin for only a month at the time, so maybe that's the difference? Hopefully, Magic will get back to his regular self, but I would definitely keep a close eye on him.

For the longest time after the hypo, I started getting nervous when I was away from home for 4 hours. I was sure I was going to come home to kitty face down on the floor again or worse. BUT, thanks to the information, support and knowlede from this site, I can now leave the house with confidence! The folks here are very experienced and I'm sure we can help get Magic back on the right track. You're in the right place! :YMHUG:
 
Was the booster shot a vaccine or insulin? It isn't clear from what you write.

If it was insulin, that doesn't follow the pattern of how most folks give insulin. Usually, folks are giving insulin every 12 hours and are testing before a shot, to be sure it is safe. Until folks have collected a lot of data on the cat, we generally suggest you not give insulin below a reading of 200.

While you're getting the hang of home testing, you may find some of the Secondary monitoring tools in my signature link helpful.
 
Welcome! A couple of questions. Was he started at 4 units or did you gradually up the insulin over time? Has his food been changed lately to one with lower carbs?
 
Thanks everyone for the kind words and support. It helps me to know that I'm not in this alone.

To clarify a bit... When we went to the vet Saturday he was given what I call a booster shot which is the once a year 4 in 1 (I think that's what it's called). We do rabies here every 3 years and he's not due for that until next year. The booster wasn't insulin based. Also, he was ok Saturday night and Sunday morning. He crashed Sunday night (typo on my part).

I've tested him every 12 hours since we have been home yesterday. He tested at 193 at noon today prior to 1/3 can of wet food. At 330p he was at 170. I am planning to test again before I go to bed then will test at 3am. He still hasn't hit 200 so I'm not giving any insulin until (or if) he does.

He was originally on a diet of 1 can of fancy feast a day and grazing on Purina One Hairball. He started at 2 units 2x a day when first diagnosed and then progressed to 3 then 4 units as of March 2012. He has been fine up until this weekend's issues. I have moved to a different county this past year and have had to leave my vet of 20+ years behind, so he's seen a different vet for all of 2012 than who diagnosed him. It wasn't until I went to the new vet in January of this year that he started on Purina DM. The vet here said no canned food at all. Both cats liked the DM and it went further since they weren't eating as much but financially I just couldn't handle the cost. I was in the process of a divorce and am on a limited income since I don't work due to health issues. Now both cats eat Purina Naturals, which is the closest I could find to nutritionally match the DM. What kind of canned food is best for these situations?

The only other tidbit of info that I left out was that we were using a freshly opened bottle of Lantus for his Saturday PM, Sunday AM and PM injections. Not sure if that plays into this or not.

He seems more perky this afternoon but is still not himself. I'm assuming that he's just wiped out and needs to recover from all of this, like anyone would that has been through this much turmoil.

Thanks again!
 
Just wanted to share that he jumped up onto his perch that is behind me while I'm on the computer, so he's definitely feeling better!! :RAHCAT
 
I joined the Lantus group last night but haven't gone through any posts yet. I must tell you though that your kitty looks just like Mags! I'm hoping to get a pic of him up soon. I have so many and most have "cattitude"..LOL
 
Sounds like he is doing better! That's great. I feed my Samwise canned Fancy Feast. Why would the vet say no canned, canned is good for our sugar kittys as they are meat eaters not dried kibble eaters. Sheesh. Vets are a pain in the butt, especially the ones who know nothing about feline diabetes. They probably kill more cats than they cure with the stupid notions they put out. My last vet was really pushing the Purina DM the dry and I just flat out told her no, I wasn't going to buy it. I am not feeding my cat dry food. Canned Fancy Feast (classics) are the best for my cat. I now have a different vet that seems to know a bit about the diabetes and switched Sam to Lantus (he was on PZI) and though she still tries to get me to buy the canned DM I won't spend the money on it and Sam hates it anyway. He also eats a lot of Friskies Pates.
 
The vet that I started to use here seemed nice enough. He is an older gentleman and was referred by my best friend who has taken her Chihuahua and at least 10 cats to him over the years. What I didn't like was that the clinic was only open limited hours and was walk in only. I tried to take him Friday afternoon and there was an over 2 hour wait, probably because it was the first of the month. They have two other locations so I asked if I could go to one of the other ones on Saturday - which I found out are appointment only. The drive was about 15 more minutes but the vet who took care of him has been awesome. She not only saw him first thing Monday morning with no appointment, she has also called me a few times to check on him. Yesterday was her day off yet I still heard from her. I've also found out that they do have an emergency service although I think it would have been too late for him if I had taken him there. There is another ER in the county, much closer to me which I will utilize in the future. As to why the male Dr pushes the DM... possibly additional revenue for his clinic? The female never even brought it up.
He's been a FF kitty his entire life up until DX and loves it. I'm just going to give him what he likes from now on since it seems like the better choice.
 
There is NO dry food, prescription or otherwise, that is appropriate for a diabetic cat. Even the Purina DM is too high in carbs for a diabetic, and the Purina Naturals certainly is. Any canned food under 10% carbs is ok to feed...you can find cat food nutrition charts here: http://catinfo.org/docs/Food Chart Public 9-22-12.pdf. Fancy Feast is a popular food to feed diabetics here because it's low carb, reasonably priced, and easy to find. Here's a link to the diabetic safe flavors of Fancy Feast: http://www.felinediabetes.com/glutenfree.htm

It's very important you get rid of the dry completely--even just a few pieces can cause a cat's blood sugar to remain high.

Unfortunately, not many vets dose Lantus correctly. Unless you have a very large framed cat, like a Maine Coon or a Bengal, 2u was too high a starting dose, but it's likely the higher carb diet you were feeding kept him from crashing. Lantus is only guaranteed to work for 28 days, but if the vials are handled carefully (refrigerated, not being jostled, and you're not shooting insulin back into the vial when you draw the dose), they can last up to 6 months. I never got that long out of Lantus--it always pooped out on me at 2-3 months. So if you were shooting with old, ineffective insulin, and raising the dose up to 4u based on that, and then shot that 4u of effective insulin--well, that's why the hypo incident happened.

Once you get rid of the dry food and go back to feeding the low carb Fancy Feast, it's VERY likely he won't need much more than 1u of insulin, so make sure you're lowering the dose. You might even want to just start over at 1u.
 
He would rather have Fancy Feast than dry, so I went out today and got him several cans based on the nutrition chart that Dr Lisa put together. If he has wet accessible he won't eat dry and the other cat won't eat wet, so it works out.

I do have a hypothesis about what has transpired....
I was using a vial of Lantus that was about 4 months old. I have a feeling that his BG has been dropping and that the Lantus was not fully effective due to it's age. The combo of the stress of the vaccine and the new vial of Lantus caused him to crash.

My vet called today to check on him and was happy to hear his numbers and that he seemed to be close to being back to normal. She has instructed me not to give any insulin unless he goes over 200 and then to call first - regardless of time of day. I have a feeling that we are going to be OTJ!

Thanks again...
 
vampfaye said:
If he has wet accessible he won't eat dry and the other cat won't eat wet, so it works out.
You really should take ALL your cats off the dry food, completely. Unless you wanna risk repeating this whole diabetes experience all over again with your other kitty...

Dry food is terrible for cats; all cats, not just diabetics. And feeding a dry food diet massively increases the chance of a kitty becoming diabetic. Even the expensive prescription dry diets.

Dr Lisa's site has a load of good info on transitioning dry food addicts over to wet. Have a read through it, and see if you can get kitty number 2 onto the Fancy Feasts also; it'll be so much better for them in the long run.

H
 
Helene & Cleo said:
vampfaye said:
If he has wet accessible he won't eat dry and the other cat won't eat wet, so it works out.
You really should take ALL your cats off the dry food, completely. Unless you wanna risk repeating this whole diabetes experience all over again with your other kitty...

My plan is to eventually try to get her onto wet as well but part of the problem is that she's just not real... shall we say.. swift? :dizcat She does good to realize she has to use the litter box. My mom has one from the same breeder, and we think that they are both severely inbred. She has a very low IQ and doesn't like changes at all. Anything new scares her. It will be a very slow transition if it happens at all. One challenge at a time...
 
Sounds as if you are going to visit the falls! dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat flip_cat flip_cat flip_cat flip_cat flip_cat
 
sueandsamwise said:
Sounds as if you are going to visit the falls! dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat dancing_cat flip_cat flip_cat flip_cat flip_cat flip_cat

Had to look that one up! I love it! Thanks for the support!
 
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