First hypo attack

[Sarahand Jeffery]

Hi all,
Thanks for these forums, they have been very helpful since my fiv+, 11 year old cat was diagnosed as type 1 in September. He is on 4.5 units twice a day of Caninsulin and his last fructosamine test was a month ago, which for the first time showed him as just a touch above the maximum ideal level.
Tonight I happened to wake up in the middle of the night because I knocked my water over, very unusual and incredibly lucky because Jeffery was acting very odd. Confused, wobbly on his feet and generally didn’t seem to know his way around. I suspected hypo so immediately put some glucose syrup on his gums and gave him a pouch of wet food (he is usually on dry, but the wet he adores and would eat right away)
I don’t have a blood glucose monitor at home as my vet said they weren’t really necessary, but I shall certainly be buying one now for those moments.
Took him to the emergency vet, by which time he had become less wobbly but still confused. They did a blood glucose test and be was 4.2, still on the low side and presumably had gone up after eating so it confirmed he was hypo.
We are home now, 3 hours after me first finding him. He has eaten another pouch of wet food and I gave him a little more glucose - still not wobbly but he is definitely still disoriented and not acting his normal self. He seems to not know what to do with himself and is pacing a bit. Also licking his lips a lot.

Is this normal after a mild hypo attack, even when sugar is on the up? How long does it normally take for them to return to normal behaviour?

My normal vets opens in 90 mins and going to call them to see if we can bring his next fructosamine test forward a week to this week, in case it shows his dose needs to come down, and also see what they recommend for today.

Any wise words from people who had experienced similar much appreciated!

 

[Wendy&Neko]

Your vet is very wrong about not home testing. It is an essential tool to keep him safe. Would your vet not home test if they had a diabetic child? If you let us know what country you are in, we can help recommend a good blood glucose (BG) meter to get. If you home test, you get much more immediate answers and don't need to get fructosamine tests done.

I strongly recommend you reduce his dose of insulin. You don't want him on an insulin dose that can potentially send him hypo again.

Caninsulin is not the best insulin for cats. It's the same one my vet started us on several years ago. Now, the recommendations are either Lantus or Prozinc for cats, which are much gentler and longer lasting insulins.

Licking his lips sounds like he's nauseous or maybe the syrup is stuck on his gums?

I recommend reading these two posts, the first one describes symptoms:

• How to treat HYPOS - THEY CAN KILL! Print this Out!!
• jojo and bunny's HYPO TOOL BOX

 

[Sarahand Jeffery]

Thank you for replying - I am in the UK. There has never been any mention of any other types of insulin as an alternative! I’ve managed to get an appointment for 5pm today, so will mention them then.
It is now 5 hours since I first found him and the licking has stopped and he seems to have settled a bit. Planning to skip his morning dose until I have seen a vet because I’ve read on here that missing one dose is ok. I’ll see if I can get a human blood glucose monitor today as they seem to be about £20-£30 and the pet ones are over £100

 

[Bron and Sheba (GA)]

Please let us know how you got on at the vet

 

[Larry and Kitties]

There has never been any mention of any other types of insulin as an alternative!

You vet should prescribe ProZinc next. Because of the Cascade, a UK vet can't prescribed a non-animal proved insulin (and other drugs) until the animal approved drugs have been show not to work.
https://www.gov.uk/guidance/the-cascade-prescribing-unauthorised-medicines

 

[Wendy&Neko]

Here are a couple posts that might help you:

• Food, Insulin, and Other Supplies
• UK Cat Food List

 

[Sarahand Jeffery]

Hi there, thanks for the info all. Just back from vets.
She suspected it happened because of a combo of him not finishing his dinner last night (though he had eaten what we agreed the ‘minimum’ would be to have his jab) and an upset tummy he has had recently, potentially meaning he wasn’t absorbing nutrients as much.
I asked her about the other insulin and she knew ProZinc was made specifically for cats, but said she would have to consult with an expert on it to learn more (incidentally I found on this website about the potential for overlap and hypo with ProZinc, but that clinical hypo is rare; has anyone had trouble? https://www.vin.com/apputil/content/defaultadv1.aspx?id=7054635&pid=12886&print=1 ). So I think we are stuck on Caninsulin for at least the immediate future.
I bought a blood glucose monitor this morning and cannot for the life of me get enough blood from his ear to do the test, how do you all manage it?
When the vet did his blood glucose, 21 hours after last insulin and 14 since hypo event, it was 16. Strangely encouraging to see the old high numbers-so she has recommended his full dose tonight as long as he eats well. I confess I am considering making it a bit smaller this once to be safe while I sleep.
His fructosamine was due next week so we brought that forward to today to see what he has been like past few weeks.
She gave me the tip that if he ever doesn’t eat a full meal, that as long as he has half give him half his insulin. He gets upset tummies a lot with his FIV so this is a good tip.
Other than that, Jeffery has returned back to normal behaviour which is a huge relief! Long may it last…

 

[Wendy&Neko]

Much less chance of hypo with Prozinc than with Caninsulin. Caninsulin hits hard and fast and more of a worry if kitty doesn't eat enough food. The article you linked is 11 years old now. Read the first thread I linked, including what the Royal Vet Clinic now says is standard first choice insulin in the UK - hint, it's Prozinc.

Glad you reduced the dose a bit, you don't want a repeat.

 

[squeem3]

I bought a blood glucose monitor this morning and cannot for the life of me get enough blood from his ear to do the test, how do you all manage it?

Hometesting tips are here: https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Warming the ear helps improve the blood flow. There are various ways to do this. The most popular method is the "rice sock": take a small cotton sock (baby size is plenty big enough but use what you have), fill with uncooked rice or dried beans / lentils (amount depends on size of the sock. Baby sock - a tablespoon or two. Adult sock - try less than 1/4 cup), tie the sock close. Put the sock into the microwave and heat until comfortably warm enough to hold in your hand without burning for a minute. Try 10 seconds to start and adjust as needed. Wrap the warm sock around the edge of the cat's ear for a good minute if possible. Hold the sock inside the ear. You should be able to clearly see the ear vein running along the edge of the ear. Use the lancet (with or without the device) to firmly poke the furry outside of the ear between the vein and the edge. If you hit the vein, no big deal. Get the blood onto the test strip and let the meter do it's think while you hold a tissue to the ear to stop bleeding.

If you're using a lancet device, try adjusting the depth setting. Start with the lowest and work your way up. Press the lancet device firmly against the ear to ensure that the lancet will prick the skin. Some people have better luck freehanding the lancet without the device.

 

[Sarahand Jeffery]

Much less chance of hypo with Prozinc than with Caninsulin. Caninsulin hits hard and fast and more of a worry if kitty doesn't eat enough food. The article you linked is 11 years old now. Read the first thread I linked, including what the Royal Vet Clinic now says is standard first choice insulin in the UK - hint, it's Prozinc.

Glad you reduced the dose a bit, you don't want a repeat.

Thanks I read that too, so I’ll definitely bring the evidence to the vet. Last time they had to consult with an expert on something (not the diabetes) I had to pay for that expert’s time, so I hope this isn’t something I have to do for this

 

[Sarahand Jeffery]

Hometesting tips are here: https://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

Warming the ear helps improve the blood flow. There are various ways to do this. The most popular method is the "rice sock": take a small cotton sock (baby size is plenty big enough but use what you have), fill with uncooked rice or dried beans / lentils (amount depends on size of the sock. Baby sock - a tablespoon or two. Adult sock - try less than 1/4 cup), tie the sock close. Put the sock into the microwave and heat until comfortably warm enough to hold in your hand without burning for a minute. Try 10 seconds to start and adjust as needed. Wrap the warm sock around the edge of the cat's ear for a good minute if possible. Hold the sock inside the ear. You should be able to clearly see the ear vein running along the edge of the ear. Use the lancet (with or without the device) to firmly poke the furry outside of the ear between the vein and the edge. If you hit the vein, no big deal. Get the blood onto the test strip and let the meter do it's think while you hold a tissue to the ear to stop bleeding.

If you're using a lancet device, try adjusting the depth setting. Start with the lowest and work your way up. Press the lancet device firmly against the ear to ensure that the lancet will prick the skin. Some people have better luck freehanding the lancet without the device.

Amazing tips, thank you I’ll try that and let you know how we get on!