Gave 4x too much, what now? Resolved.

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pantherkitty

Member Since 2021
Ten minutes ago, I had a brain fart... I drew the usual 3-4 units of Lantus, then forgot to expel it down to the usual 3/4 unit before injecting it.

She has a Freestyle Libre, and her last reading was 168 (normal for the morning). 3/4 unit would normally get her down to 100 or so within 2-3 hours, and keep her within 90-120 for ~12 hours. She normally eats small amounts (1-1.5oz) of wet food every 2-3 hours throughout the day, augmented by dry food if she falls below 90, and force-fed honey if she falls below 60.

I know I need to radically increase her glucose intake for at least the next 12+ hours... but how much? I was thinking about mixing sugar into her wet food (since cats supposedly can't taste it anyway), but I need guidance about how much.

How much of a buffer should I strive for, within the next hour or two before it starts to kick in, and once it does? And when should I start to back off the glucose-augmentation? Should I give her no dose tonight, or a tiny (say, 0.5u) dose?

I know the upcoming insulin tsunami something that can be managed, but it's the first time it's happened, so I'm not sure about the fine details.
 
@Wendy&Neko @Bandit's Mom @Marje and Gracie

I am not an admin and have never overdosed my cat, but I would start with the HC now. And I would also check every hour at least (maybe even every 30 minutes) for the entire cycle depending on how you see the numbers going. She has her usual NADIR patterns I know, I don't know how an overdose might affect that and if you can expect her normal NADIR times or not.

Please BE READY to go to emergency clinic if you cannot control the drops with advice from the admins here. That is a big overdose. In fact, you can call them now and let them know you might be coming. Call your own vet and have them fax over records now. This way if you go, the ER is ready for you and your kitty.

ALSO, very important. Please edit your title and select the 911 red from the drop down menu!!

ALSO, do you have a spreadsheet? If so you need to please link it here, so people can properly help you. If you do NOT, then start writing down all your numbers and post them here.
 
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Great! Deleted my post instead of editing it! :rolleyes:

Wanted to add that if you do not have a spreadsheet but have test data, I can quickly set up a spreadsheet for you.

Please get a +1 and post here. Thanks.
 
If it were my cat, I would take it to the vet or emergency clinic for monitoring, depending on the time of day and who is open right now. Just to be safe... I don't know how long it would take you to get there if things get bad... but time is of the essence.
 
I agree with Margaret on feeding but I’d also be testing every half hour and if she starts coming down, feed HC, have syrup and a plan ready to get to the ER as soon as you see her starting to come down very much. Onset is usually at +2 and it’s possible she will drop suddenly.

To be extra cautious, I’d call my vet right now and see about taking her there immediately for monitoring for the day. They should be able to quickly get her on a glucose drip if needed and it would likely be less expensive than an ER.
 
Sorry about the delay, here's an update.

I got her glucose up to 190 about an hour after injection by giving her a can of Fancy Feast w/3 tbsp of Karo mixed in (she ate ~half), then took her to the vet as a precaution. I had to take my dad to get his covid shot this afternoon, and didn't feel safe leaving her unattended for the 3 hours or so it'll take (he's getting his shot now). The vet is giving her IV glucose (or some other sugar) & keeping an eye on her in the meantime.

I'll be picking her up at 5 or 6 (the vet's office closes at 6). I'm sure they'll vigorously advise me to take her to a 24 hour emergency clinic, but assuming they can keep her buffered up to around 200(?), I should be able to keep her from falling below 100 just by giving her constant food+Karo for the next 6-10 hours after that, & don't have to panic unless she falls below 100, right? (100, because it'll presumably keep falling & be <60 by the time she actually gets hooked up to another IV 30-45 minutes later?)
 
pantherkitty said:
Sorry about the delay, here's an update.

I got her glucose up to 190 about an hour after injection by giving her a can of Fancy Feast w/3 tbsp of Karo mixed in (she ate ~half), then took her to the vet as a precaution. I had to take my dad to get his covid shot this afternoon, and didn't feel safe leaving her unattended for the 3 hours or so it'll take (he's getting his shot now). The vet is giving her IV glucose (or some other sugar) & keeping an eye on her in the meantime.

I'll be picking her up at 5 or 6 (the vet's office closes at 6). I'm sure they'll vigorously advise me to take her to a 24 hour emergency clinic, but assuming they can keep her buffered up to around 200(?), I should be able to keep her from falling below 100 just by giving her constant food+Karo for the next 6-10 hours after that, & don't have to panic unless she falls below 100, right? (100, because it'll presumably keep falling & be <60 by the time she actually gets hooked up to another IV 30-45 minutes later?)
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I am so very glad your cat is at the vet now. Please do NOT give insulin tonight, UNLESS the admins here advise you to do so. Lantus is a depot insulin which means it builds up in the system and stays there for awhile. So this overdose can affect your cat for up to 6 (!) cycles. So, believing you will be out of the woods in 6-10 hours I don't know if that is accurate. You may need to be vigilant for the next 3 days as the amount of insulin in your cat's body dissipates little by little.

Make sure you get specific guidance from the admins here before you give insulin again - whether that is tonight, tomorrow, the next day, etc.

I can't advise about keeping her home or taking her to ER vet overnight. But in case you decide to go, it would be good for your vet to send you home with a paper copy of your cat's records in case you need to go to emergency. Maybe they can even call the emergency clinic themselves to prepare the way for you, in case you go there.

@Marje and Gracie @Wendy&Neko @Bandit's Mom @tiffmaxee
 
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around hour 6.

As of ~30 minutes ago, her glucose was around 350 according to the vet, so it sounds like she's pretty well-buffered right now.

I was planning to cut her next 2 or 3 doses to ~0.5 units, and/or go 15-18 hours between doses for a day or two (to avoid skipping doses entirely, but defer them if she's < 100 at t=12)
 
Insofar as her numbers go, is there an easy way to just populate the spreadsheet mentioned above directly from her Freestyle Libre data?

Update (glucose readings via Freestyle Libre)

5pm: home from vet, glucose was 190. Gave some Fancy Feast mixed with Karo.

5:30 glucose fell to 160. Gave her three 1.5mL mouthfuls of Karo about 5 minutes apart.

6:00 glucose up to 190. Gave her a full bowl of dry food (normally, she only gets it a dozen or two kibbles at a time when her glucose falls below 80). She wolfed down enough to fill 2 or 3 ping-pong balls.

7:00 glucose up to 290. I took away the food and decided to watch her glucose for a half hour or so before giving her more. According to her Libre history, the vet stopped giving her the IV when she was around 350, so I'm assuming that I don't want to shoot her up past 350, either.

7:15 (15 minutes after I wrote the above update), her glucose is 322 and still increasing at around a 45-60 degree slope. It looks like it's a good thing I took away her food 15 minutes ago.

At what point tonight should I lay off trying to carb-load her and allow her glucose to fall below, say, 200 or 150, before encouraging her to eat more (let alone force-feed her Karo)? I've been checking her Libre every 5-10 minutes, so I'll know when she starts to fall again & how quickly.
 
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It depends on where you are in the cycle, and if she can stay up on her own without help from food.
Keep a close eye on her and test as often as you doing now, ill tag @Wendy&Neko for you. Hopefully she has the answers to your questions.
And please take Bhoomas help with the spreadsheet :bighug:
 
Another update. It looks like 7:15 (about 15 minutes after I took the food away from her) was close to her peak glucose. It's back down to 226 now, and the downward slope is almost exactly identical to what was previously her upward slope. So, I'm giving her the dry food again to chow down on until her glucose is back above 270 or so.
 
pantherkitty said:
At what point tonight should I lay off trying to carb-load her and allow her glucose to fall below, say, 200 or 150, before encouraging her to eat more (let alone force-feed her Karo)?
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Sorry, but I can't help without a spreadsheet. Hopefully we can get you set up with that soon. We've had a number of people here use the Libre so there's a way to get that data in.
 
My apologies I only just saw this! There is the Libreview website where you should have a login setup (it's what you use to login to the app) from there you can "view glucose reports" that shows you the curves. Or, what I like to do is click on "download glucose data" or words to that effect, upper right side of the screen and it makes an excel CSV file that you can look through. The first long list of numbers is the system numbers it's saved usually in increments of 15min. The bottom of that list then has all the scans you've done. From that you can pull a huge amount of data and pretty much fill in every square of the spreadsheet. It's a little time consuming but so worth it once it's done.
 
so pleased to hear your kitty bounced back - very frightening but good job you realised what you had done when you did! I wonder if I could ask you where the freestyle libre sensor is fitted. My little chap keeps biting them off with his skin still attached to the sensor (ouch) and we have put two in his neck and they don't read. He is super skinny which doesn't help.
 
Pabs&Ro said:
I wonder if I could ask you where the freestyle libre sensor is fitted. My little chap keeps biting them off with his skin still attached to the sensor (ouch) and we have put two in his neck and they don't read. He is super skinny which doesn't help.
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Hi there, I have some experience with this. My Minnie had a total of 10 libre and became allergic to the adhesive which made her do the same thing (there's a whole facebook group for humans with this allergy). She was fine with the first 4 sensors then the same as you describe. She had them placed on her shoulders and further back but could get at them all until we got this collar recommended by my vet https://www.amazon.com/gp/product/B01C2LU5M2/?tag=felinediabetesfdmb-20. They come in different designs/fabric but this was super soft and had long velcro strips which made it easy to take on/off. She actually wore it 'down' so it looked like she was in a skirt, not 'up' as they show in the ad. I bought a few sizes to try - it was a little long so she had to learn to walk in it, but she could not get to the sensor. I also tried a baby outfit and pet pjs but she still managed to remove the sensor, once it fell out of the sleeve!

I also saw someone recommend using feeding tube collars though never tried it (we discontinued the libre) https://www.kittykollar.com/

Or look at the attachment in this post (Figure 8) for a cheap and easy alternative "simply fashioned by pinning together the top and toe of a sock around the neck."


ETA - I should have started with, so good to hear that pantherkitty recovered....I think everyone's worst fear (mine at least when I started - my first shot I initially drew up 10u instead of 1, luckily looked at the syringe and thought that didn't seem right). Glad to hear you were able to contain things and I bet you'll never do it again. :bighug:
 
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@Liz & Minnie Thank you for that information. Very useful. We are applying it a little higher up on his neck. I have just checked him and there is no flesh a couple of inches lower where it is applied in fig 8. I have bought two more sensors but I think I will just have to wait until he has put a little weight on. Just read you info and your poor little girl has been through the wringer!
 
Pabs&Ro said:
@Liz & Minnie Thank you for that information. Very useful. We are applying it a little higher up on his neck. I have just checked him and there is no flesh a couple of inches lower where it is applied in fig 8. I have bought two more sensors but I think I will just have to wait until he has put a little weight on. Just read you info and your poor little girl has been through the wringer!
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Hi there! I read through your ordeal the other day and was very concerned. I’m glad your kitty has come through this okay. We all make mistakes. One thing that I wanted to mention is that it is not a good idea to draw up a whole bunch of excess insulin into your syringe and then expel it back into the vial (or pen). The inside of the insulin syringes are coated with silicon so that they slide more easily. If you draw up too much and then put it back into the vial you can potentially contaminate the insulin. This could shorten the shelf life of the insulin. I was always advised to just draw up as much as I need and to expel any tiny amount out onto the counter or sink or a paper towel. Just a thought. Maybe you weren’t really putting the insulin back into a vial and I misunderstood.
 
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