First hypo- feedback appreciated

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Thesixs

Thesixs

Member Since 2016
This morning Truman was at 90, I have him 2.5 units and asked my daughter to keep an eye on him. At noon he was lethargic and had loss of muscle control. She gave him honey orally and rechecked at 1 oclock and he was acting better but was at 37 so she fed him. At 130 he was at 50. At his usual feeding time 7 pm his BS was 92. Fearing another hypo I decreased his insulin to 2 units. I plan on checking him this evening.

What would you have done different?
 
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Did you give 2 units tonight at 92? Sharon is correct. New diabetics should not get insulin under 200.

I am worried he will drop low again tonight. Please get tests, starting at 1 hour after the shot, then every hour or so if he is dropping. If he gets into the 50s, give him some regular food and retest. If he continues to drop, put some honey on his gums.

I am very concerned that he will hypo again, and a second hypo in the next cycle can be even more dangerous.
 
Sharon14 said:
We don't usually recommend giving insulin when below 200. I'll tag @Sue and Oliver (GA) and @Rachel to help you with future doses.
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I had read that about not giving under 200, and I tried that, but he was bouncing all over the place (see spreadsheet). So I opted for a modify dose/shoot/and watch approach. He seemed to be stabilizing these past few days. I forgot to add in my original post that I suspect he vomited after eating this morning. One of the 4 cats did but I'm not sure which.
 
Sue and Oliver (GA) said:
Did you give 2 units tonight at 92? Sharon is correct. New diabetics should not get insulin under 200.

I am worried he will drop low again tonight. Please get tests, starting at 1 hour after the shot, then every hour or so if he is dropping. If he gets into the 50s, give him some regular food and retest. If he continues to drop, put some honey on his gums.

I am very concerned that he will hypo again, and a second hypo in the next cycle can be even more dangerous.
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Thank you, I will!
 
After today's hypo numbers he did get a reduction but with a 92 tonight, no shot should have been given. As Sharon and Sue said, when this early in the diabetic dance you don't want to shot under 200 until there is more data to see how he reacts to a certain dose. This is all a learning curve so going forward now, PLEASE test often to make sure he is safe and steer him according. If he starts to drop early on in the cycle you will need to be vigilant through the nadir which is anywhere from +4-+7. Do you have some High Carb food ?

Bouncing is all a part of this dance while getting him into better numbers. Once he gets used to being in normal numbers the bouncing slows down or stops. Some cats bounce all the way into remission.

Please stay on top of testing tonight. I am very worried for him because from what you described he had a symptomatic hypo event today which can make him very sensitive to insulin tonight. So be vigilant.
 
Bobbie And Bubba said:
After today's hypo numbers he did get a reduction but with a 92 tonight, no shot should have been given. As Sharon and Sue said, when this early in the diabetic dance you don't want to shot under 200 until there is more data to see how he reacts to a certain dose. This is all a learning curve so going forward now, PLEASE test often to make sure he is safe and steer him according. If he starts to drop early on in the cycle you will need to be vigilant through the nadir which is anywhere from +4-+7. Do you have some High Carb food ?

Bouncing is all a part of this dance while getting him into better numbers. Once he gets used to being in normal numbers the bouncing slows down or stops. Some cats bounce all the way into remission.

Please stay on top of testing tonight. I am very worried for him because from what you described he had a symptomatic hypo event today which can make him very sensitive to insulin tonight. So be vigilant.
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Thank you! I do have dry food and he loves it. According to the curve done at the vet his low is +6. He is at 67 right now, I'm watching him closely. I'm an EMT so I'm used to hypo in humans, but this is the first with an animal.
 
With him dropping already, I'd strongly suggest you be looking into the nearest ER clinic

I don't mean to scare you, but after a symptomatic hypo like it sounds like he had this morning, and as quickly as he's dropping, you may not be able to handle this at home

Usually we expect the number to go up at +1 because we've just fed...he's already dropped about 1/3rd
 
Chris & China said:
With him dropping already, I'd strongly suggest you be looking into the nearest ER clinic

I don't mean to scare you, but after a symptomatic hypo like it sounds like he had this morning, and as quickly as he's dropping, you may not be able to handle this at home

Usually we expect the number to go up at +1 because we've just fed...he's already dropped about 1/3rd
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Fed him some dry, Gabe him some marshmallow fluff on his gums, and called the vet. Monitoring for now as per vet. Thank you!
 
Thesixs said:
A human meter. Forgot to add that to signature. Relion prime.
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Okay, that's good. Do you have any high-carb gravy style food? You can feed just some of the gravy to help bring BG back up, it helps keep kitty from getting too full in case you need to feed later. If he drops below 50 you can give small amounts of Karo syrup or honey, it works fast but doesn't have a long duration, so best to use it in conjunction with a HC food/gravy.

You will need to test Truman very frequently. I agree completely with Chris & China, I would be prepared to take him to the ER vet as this may not be manageable at home!
 
Have given him some honey and instaglucose ( I carry it in my trauma bag) He's acting pretty normal although he registered at 37 at +2. I have no high car gravy type food. Vet says as long as neuro functions are good keep doing what I'm doing.
 
You need to get his glucose up over 50, at the very least. Please test him every 20 minutes and keep giving him the honey and instaglucose (not familiar with it but I assume it is safe for cats) until he stabilizes. Have you fed him any of the dry food? It is high carb so it will help some, but it takes it a little longer to take effect.
 
I am really very worried about Truman. Just to be clear - if he tested 37 at +2 and his usual nadir is around +6, there is still at least four hours left in which he may continue to drop. This can get out of control very quickly and could potentially become fatal. I don't know why your vet wants you to wait, but if he was my cat I would be heading for the Emergency Vet.
 
I am with Squalliemom on this! I have been through an almost fatal hypo and my kitty was at 26 after putting honey on his clenched teeth when I got to the ER with him!! This is not something to listen to your vet about!!!!!!
 
You do know that any number under 50 is dangerous, right? The ss shows he hypoed at least two other times before on 7/31 and 8/11. I'm fairly sure probably a few other times with shots given at low preshot numbers.
 
I really appreciate all of your concern! At +2.5 he's at 39. Up 2. Gave him more Glucose and the gravy from the dogs canned over dry special kitty. He's bathing and acting normal. Continuing to monitor very closely. He's not out of my sight.

We live very rural and have no ER vets or 24 hour clinics. So I have to go with my vets recommendation.

Thank you all, I will keep posting.
 
JanetNJ said:
You do know that any number under 50 is dangerous, right? The ss shows he hypoed at least two other times before on 7/31 and 8/11. I'm fairly sure probably a few other times with shots given at low preshot numbers.
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I do realize that under 50 is dangerous. I am still learning a lot though. Until today when my daughter noticed his lethargy he's never had any neurological signs of hypo. I'm really thinking about buying another meter as I get a lot of errors with this one. I have noticed an increase in errors with the new bottle of strips I opened last week.
 
Some cats have no symptoms when they drop until they have a seizure. We watch the numbers and react to those rather than look for any symptoms. Hope you can watch carefully and keep him going up, not dropping. We suggest waiting for 3 rising tests over 50, after +6 at least, before you relax.

Definitely needs a dose reduction. He may be high tomorrow (bouncing from these lows) but I would reduce the dose.

What would you think about a reset? We generally suggest starting at one unit and raising the dose slowly as your testing indicates. You could start at one unit. (Always easier to raise slowly every few cycles than deal with hypos)
 
Thesixs said:
I'm really thinking about buying another meter as I get a lot of errors with this one.
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We hear that quite often about the Prime...You might want to get one of the Relion Confirm or Micro meters instead...not only do they take the smallest sample size, but the strips have a "wicking action" that sucks the blood up into them....take a very tiny drop of blood to get a good test

The strips aren't as cheap, but they're still affordable at $35.88 per 100
 
Sue and Oliver (GA) said:
Some cats have no symptoms when they drop until they have a seizure. We watch the numbers and react to those rather than look for any symptoms. Hope you can watch carefully and keep him going up, not dropping. We suggest waiting for 3 rising tests over 50, after +6 at least, before you relax.

Definitely needs a dose reduction. He may be high tomorrow (bouncing from these lows) but I would reduce the dose.

What would you think about a reset? We generally suggest starting at one unit and raising the dose slowly as your testing indicates. You could start at one unit. (Always easier to raise slowly every few cycles than deal with hypos)
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Our vet suggested dropping to 2 units. I am sending her the spreadsheet tomorrow, then she will call me with a definite.
 
Glad you are able to keep Truman's BG up! You still have a couple of hours to go, so stay vigilant and keep testing! :)

My Squallie has had two hypos, and he was asymptomatic for both of them; I wouldn't have caught them, possibly until it was too late, if I hadn't tested him. I also use the Relion Confirm, have had no problems at all with it.

ETA: I like Sue and Oliver's idea of a reset. I think this would be the best way to get Truman back on the best dose for him.
 
+6 and he's at 85. I had to take the reading twice, the first time it said 263. Didn't believe it. I'm really suspect of this meter now.
 
I would get at least one more test to see if he is still rising. When was the last time you gave him anything to help bring his BG up?
 
Next time you go out, you should pick up something like Fancy Feast Gravy Lovers foods....always good to have around in these cases!

We generally pop the top, then put it back and "squeeze" the gravy part into another bowl...usually a teaspoon or two is enough to get them up without worrying about filling them up so they're not willing to eat again if we need them too

Good job tonight!
 
Chris & China said:
Next time you go out, you should pick up something like Fancy Feast Gravy Lovers foods....always good to have around in these cases!

We generally pop the top, then put it back and "squeeze" the gravy part into another bowl...usually a teaspoon or two is enough to get them up without worrying about filling them up so they're not willing to eat again if we need them too

Good job tonight!
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Thanks! Will do that!
 
I would also seriously give some thought to reducing him back down to 1 unit and working your way up so you know you haven't bypassed what could be a "perfect" dose for Truman
 
Oh boy, sure glad you got that +1 test to see that he was dropping so fast. Please heed the advice here and drop him back to 1 unit and let us help you with a restart. The 2 units your vet recommended was too high for him too. When you test this AM and if he is under 200, please do not shot. With two hypos in a row he could become extremely sensitive to insulin.

I am so glad Truman is okay!
 
Wow, well I missed it all (sorry I didn't get the tag for some reason...happens sometimes). I'd like to just echo the recommendation to reduce to 1 unit. 2 units was way too much last night, and I think 1 unit would be a MUCH safer choice. And, as Bobbie says, if you get below 200 don't shoot.

The numbers you got in the 90s are normal for a cat. That's why they ended up in those hypos...I don't think you'll run into any prozinc users at all who would give insulin when the cat is at 90 preshot.

You did a great job last night! Let us know if we can help you with dosing.
 
First, thank you all for the help! I definetly need a different meter. This morning I took 3 readings. They were 230, 397,and 297. I decided that 230 was probably the best guess of the 3. I fed him but I'm reluctant to give him a shot this morning. (He will be alone all day) I will be buying a new meter and strips today and getting the canned that was recomended for hypo episodes. Tonight I will give him 1 unit. Thank you all again for your insight!
 
One other quick question. What is the likelie hood that vomiting after eating and insulin would set him off. I'm guessing that may be what happened.
 
The readings this morning are likely higher because he is bouncing. (in very basic terms: When the body perceives a level lower than it is used it, it releases extra sugar and the number rises, bouncing up to a higher level. It can take 1-3 cycles for the bounce to clear). I would say the levels this morning are lower than expected for a bounce (often in the 300-400 range), so I am still thinking I would dramatically lower the dose.

Yes, not eating or vomiting can lower the levels. But shooting insulin into a number in the 90s is the likely reason he dropped so low.
 
I'm so glad Truman is okay this morning. Definitely pick up a new meter today, if you can! I'm really glad to hear you are going back to 1U; you can gradually increase until you find the number that's right for him (and I'm betting it's less than 2U!) Good work last night keeping him safe! :)
 
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