Hi Rebecca,
NB: Some sections of this post are now redundant and I have greyed out and struck through that text. (Sorry, I passed out in the middle of typing it last night.)
I'm in the UK and about to sign off (past 2:30 am here).
When you get a moment, please can you post an update about:
* whether the honey has had any positive effect on Buddy (in particular, has he got strength back in his hind legs?).
* whether he is managing to eat anything, and if so how much and of which food (dry/wet/low or high carb).
* whether you've heard back from the vet and, if yes, what advice you've received. (If you haven't, I recommend pushing till you get a response.)
* whether you gave any insulin and, if yes, what dose and how many hours have elapsed between dose administration and the time of your post.
For future reference, I'd recommend taking Buddy promptly to an ER vet if you can't get support from your own vet out of hours.
Whatever may be at the root of Buddy's current issues, it sounds like he might be at risk of getting dehydrated, which may also make him feel lousy and even more disinclined to eat (
ways to check for dehydration here).
I'd also suggest asking whichever vet you see to check for ketones and also to run blood work to ascertain whether there might be other issues feeding into the hind leg problems and possible general weakness (e.g. potassium / phosphorus / other imbalance, as Ale mentioned above).
I'd also ask the vet to test for pancreatitis, if only to rule it out as a cause of the nausea/inappetence (Snap fPL on-the-spot test gives positive/negative/unclear results, Spec fPL returns a quantitative result indicative of degree of any inflammation present but it needs to be sent to an external lab for processing so has longer turnaround time).
Should Buddy test positive for pancreatitis then cornerstone treatments - pain management, fluids, nausea/hyperacidity control, appetite stimulation - are all covered here:
IDEXX Feline Pancreatiis Guidelines (a good document for discussions with vets).
Things to look out for and tell your vet about:
*
Nausea symptom checklist (also look to see whether Buddy might sit hunched up in a 'tense meatloaf' position, possibly with a pinched expression on his face - may indicate pain, possibly somewhere in the digestive system).
* Water consumption/urine output/any inappropriate toileting behaviour.
* Energy / mood (especially if lethargic / depressed / withdrawn)
As Bron recommends above, I think that you need to start home testing blood glucose and monitoring for ketones immediately:
(a) For now, it would probably be safer to work on the principle that Buddy may have had a protracted symptomatic hypo last night until a vet can determine otherwise (especially as the event happened about 4 hours after insulin dose administration, around the time when the blood glucose level is typically at its lowest in cats on Vetsulin, plus Buddy seemed to recover limb function following administration of more concentrated sugars).
(b) Given the possibility that last night's event was a hypo then the 1.0IU dose of Vetsulin should be treated as too high - particularly as Buddy is having difficulty getting food on board. If it was my cat, I would want to determine where Buddy's BG levels are before giving another dose, and I would look to reduce the dose, at least for the time being.
(c) Again, given the possibility of a protracted symptomatic hypo event having occurred last night, Buddy may now be more sensitive to the effects of insulin. This is another reason to be extra-cautious about insulin dose.
(d) With Buddy not eating and some as yet unidentified underlying condition driving the inappetence, skipping insulin doses carries an increased risk of his starting to generate ketones (and his being skinny might increase that risk).
My best suggestion is to get Buddy checked over by a vet as soon as possible
today, both to determine BG and ketone status and also to examine him for any possible residual effects of what may have been a protracted hypo. His ketone status is important because that has a direct bearing on insulin dosing.
Important note: If Buddy was in very low BG numbers last night, his body may produce a counter-regulatory response to the low and that can lead to a temporary rebound to significantly elevated BG levels, but there is no way of knowing when levels will drop back. I still think the dose should be reduced - at least for a time while you gather some BG readings and get a better picture of how Buddy's responding to insulin (your vets may give different advice).
The way to keep Buddy safe is to start closely monitoring his BG and ketone levels immediately, and speak to a vet about how much to reduce the dose by (plus addressing the inappetence). Without data, I can't suggest anything about insulin dose, only that the 1.0IU dose appears to be unsafe and if it was my cat I would be looking to agree a reduction with my vet.
Mogs
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