Here I am again

[Maaryon]

In April I posted as Topaz had a hypoglycemic reaction. She was treated at the Vet and did well until last week when she again had a hypo .Now I had an understanding of what was happening, tested her and she was at 55. This occurred 6 hours after her shot of 3 units Humulin N. I home treated with corn syrup and did not go to the vet. I did call him and he said she appears to be a "transitional diabetic" Has any one heard of this???
She is semi- feral. I am lucky to get testing done twice a day (a.m. and P.M.) without bites. She is 17 years old and has never had such crazy numbers. With all staying the same (food, routine etc.) she can be 327 in the morning ( given 3 units), 375 in the evening (3 units), 179 the next morning (little less than 2 1/2 units, 307 that night (given 2 1/2 units, was 322 this morning (3 units) and before giving a shot tested her and she was at 99. I alternate dosage to 2 units, or 2 and 1/2 units or nothing ( as this afternoon she got no shot) depending on her number.She gets insulin twice a day with 12 hours between shots. Any feedback on what to do? Those hypos are scary for both of us.

 

[BJM]

You may not be able to give the exact same dose each shot when the glucose levels vary like that. Have you read over the Humulin/Novolin Primer? That may help you use the insulin better. Also, if she has any appetite problems, that will affect her glucose levels, as will any infection.

Can we get you started using our grid to record your glucose tests? It will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

[Maaryon]

I understand the need for more testing however, that is just not a possibility in this case. I have had Topaz for her whole life and she has been diabetic for 13 years and in all that time we have struggled with testing. I know all the things I can do with a feral cat ( towels, holds etc.) but it is not worth the stress it causes her. She is a highly reactive cat, does not accept others ( only tolerates other family members and only at a distance) and once her ears become painful from the daily testing I can forget about testing for about a week until they fully heal. I think that maybe the solution is to cut her dosage and allow her to be higher in numbers than to keep flirting with a hypo? a lower dose at night was also suggested by a medical doctor friend of mine.

 

[BJM]

OK. You still need a systematic plan for monitoring her.
You can use a combination of the options in my signature link Secondary Monitoring Tools.
1) Water drunk - this one is key.
2) Urine ketone & glucose monitoring - also key. you can use acquarium gravel
3) Urine output volume & frequency (number & size of clumps).
4) Food eaten/appetite.

You are looking for patterns; changes help alert you that something is up.

A reduced dose at night makes sense.

Switching to ProZinc would be safer - it doesn't it as hard and fast, so the cat has some time to eat as compensation for a bit excess insulin. Do you leave any food out for her?

 

[Maaryon]

Yes before I leave for work I leave a half can of Fancy Feast and sometimes my husband will feed her a bit if she acts very hungry. I know that she is spilling in her urine as I have testing strips that turn brown, she drinks a lot, about the same amount a day ( one small bowl full) and eliminates both on a regular basis and equal amounts. Her blood work does show her kidneys are stressed but I lost the paper which had a numbers on it. I think she was comparable to stage three in that cite here on FD that describes end of life and kidney failure. The vet said she had about three months to live back in April and that was based on her kidney function.
I'll try to catch her again tonight ( she hides) and depending on her numbers, maybe gave a low dose tonight of about 1 1/2. ? Thanks for your feedback. maaryon

 

[BJM]

Humulin lasts only 6-8 hours in the cat, so there are 4-6 hours out of every 12 where the insulin isn't working. That is why you are seeing glucose spill in the urine.