HG? too much insulin - not enough?

Status
Not open for further replies.
S

Stardust

New Member
Our 13 year old baby was diagnosed in April as diabetic. We had already suspected as much, lost weight and extra drinking & peeing. We love our vet and have a good relationship with him, but he has some new vets assisting in his practice now and we don't always get to talk to him. Anyway, Stardust started with 1 unit of prozinc 2xday then leveled off at 2-1/2 units. Her symptoms were much improved, though she still would drink/pee more than we'd have liked.

We took her in for a periodic BG test about a month ago and he recommended we increase to 2-3/4 units since her BG was still a bit high and bring her back in 10 days for a re-check. All was well we thought, saw a different vet and she recommended we increase to 3 units - BG still a bit too high. Things were okay for a couple of days, then the 3rd day when I came home (about 12-1/2 hours after her morning shot) she met me at the door as usual, but seemed groggy and glazed. she slowly followed me to the kitchen for her usual treat (4 pieces of diet chow) but just stared at it. she then wandered away and just laid down. I looked around the house and found 2 pees in the bathroom floor and very little of her chow had been eaten. It was time for her 2nd shot, but I was concerned that she seemed HG. I put some honey in her mouth and in a few minutes she seemed perkier. So I prepared her wet food meal to give her the insulin. I was afraid to give her the 3 units, but also afraid I might be misreading her symptoms, so I gave her 1/2 dose (1-1/2 units) By morning she seemed fine. Her morning meal/shot went well, but I stepped her back to 2-3/4 units. The vet checked her BG a couple of days later and said it was high and to increase her to 3 units. I related the incident that had happened, which seemed to annoy her. I told her I would not give 3 units for fear of a recurrance. She then directed us to bring her in this Friday before her morning shot to get a fasting BG reading.

Last night when I got home she again seemed groggy. Not as profound as the week before, but she just didn't seem right. She ate her treats, but didn't eat much of her wet food meal. I gave her the regular insulin dose before I realized she wasn't finishing her food. She peed once in the bathroom floor overnight and didn't seem to eat or drink anything all night. She's just lying there this morning, not in her usual place.

We did buy a meter, but have never been able to get her to settle down to draw blood. She isn't a lap kitty and doesn't like to be held. The vet hasn't encouraged us to worry about it - if she eats the same food/amount each day her dose shouldn't need frequent adjusting.

I just don't know what to do. It will be time for her shot in about 20 minutes, but I don't want to dose her without her eating.
 
Your vet is likely overdosing your cat and next time you may find her dead judging by what you have written. The high numbers your vet is treating is likely because her body is rebounding from overdosing. I am on my blackberry so can't get you the links I would like to so my suggestion is to not dose today, post your location incase one of us can help you with testing and reduce the dose by half until you are testing. And buy ketostix to test her urine for ketones as these are a possible complication from poorly managed diabetes

Keep posting ok?

Jen
 
We live out in the country in southern Arizona. I am staying home from work today to keep an eye on her and can call the vet later, but our regular vet won't be in this week. I just don't trust this other vet. I know that in the short term HG is much more dangerous than high BG. I also know that just getting her into the vet will raise her levels. I just don't want to do the wrong thing. Instinct tells me she needs less insulin, not more. I think I wil skip her morning shot, but I'll try to tempt her with the wet food, just to get her to eat. Thanks for the post. I'll post our progress as the day goes on.
 
Stardust said:
The vet hasn't encouraged us to worry about it - if she eats the same food/amount each day her dose shouldn't need frequent adjusting.
Click to expand...

Your vet is wrong!!!! A cat's BG levels can easily flucuate from meal to meal even if they do eat the same thing. My cats eat the same thing every day and often I get a difference in readings with sometimes more than 100 less than the previous reading. Three units is very high for a cat. Most cats only need 1 or 2 units. Please start hometesting immediately and decrease her insulin dose.

Stardust said:
Instinct tells me she needs less insulin, not more. I think I wil skip her morning shot, but I'll try to tempt her with the wet food, just to get her to eat. Thanks for the post. I'll post our progress as the day goes on.
Click to expand...

You are right. There is a condition called Somogyi rebound which causes glucose readings to be high. This is caused by too much insulin. In order to protect itself from becoming hypoglycemic, the body produces extra glucose. However, it is only a matter of time before the body can no longer protect itself and the cat will become hypoglycemic.
 
At this point I'd give her whatever she'd eat, whether it is dry food, tuna, temptation cat treats, etc. She likely doesn't need honey at this point as its been quite some time since her last shot, correct? She likely just feels like cr*p, which makes cats inappetant. You need to get her to eat, even if it means watering down her canned food and putting some in her mouth several times a day.

Jen
 
Her shots are normally 7:30 and 7:30 except Tuesday/Thursday when I teach a night class and don't get home until about 8 or so. Her last shot was about 8:30 or so last night. I'll try not to panic, but just check on her and see if I can tempt her with anything.

We live about halfway between Bisbee and Sierra Vista AZ
 
Have you seen the links on how to hometest?
viewtopic.php?f=14&t=287

If you cant get your kitty to sit still in the beginning, you could wrap her in a towel, burrito style so she can't move and test her. It's important to try to get that BG.

Going forward we can help you with techniques to make hometesting easy, but for now I might wrap her and test her BG so we can see what's going on now. As suggested, any food that may interest her please try.
 
Update -
I called the vet's office when they opened. Our regular vet was there and I explained the whole scenario to him, suggesting that Stardust was rebounding from too much insulin. He listened patiently, (love this man who has saved the life of several prior pets) and he reviewed the last few BG tests they'd done while he was not available. He advised to give her some honey, (and to buy some white Karo next trip to the store) and give her some more in about 1/2 hour, tempt her with food as she starts acting more herself. skip her morning dose of insulin, call them in a couple of hours to see how she's doing. He indicated we should probably step back to between 2-1/2 and 2-3/4 units when she settles back down.

So, I gave her some honey. Had to drag her out from under the table, but she is just sitting where I left her, totally unmotivated to move.
 
Honestly, I doubt she needs honey when it is 12 hours post dose, and I disagree with the level of reduction as it may not be enough of a reduction. I would also highly consider no shot tonight because it can take some time for the hormones associated with rebound to settle down.

Please, get real food and water into her, get some ketostix and if she doesn't improve get her into a vet for some tests.

Jen
 
A reduction from 3u to 2-3/4u is not a significant reduction in insulin.

You do not give honey/syrup/sugar to a cat who's BG is already high.

The best way to know what is going on, is to home-test.
 
Honestly, I'm sure your vet is a great person and you like him very much. As much as he may know about other diseases and caring for animals, he is not helping when it comes to your cat's diabetes. Many vets are behind the times when it come to Feline Diabetes. It sounds as though this is the case for him.

Think of it this way....would you blindly shoot insulin into a child, without first checking their BG?? No, of course not!

Your kitty is the same. You need to learn to hometest, it's really not that hard. They don't even feel it when you prick their ear. Hopefully, someone can help you that is close by.

And I would definitely start all over with a dose 1 unit.
 
update 2 -
Stardust moved toward the direction of the bathroom about 25 steps, then peed in the floor. She just sat down on the pee once she realized she hadn't made it to the litter box. Her gait was slow and unsteady. I gave her the 2nd dose of honey and she seems a bit more alert than half an hour ago. still can't get her to eat any food. My husband on the way home from work and we may try to do the glucometer thing. we could just never get her to bleed! and she would squirm and fight. We looked at the videos and web resources when she was 1st diagnosed, but she was doing fine without testing at that point.

If she isn't better acting soon, I'll end up taking her in to the vet.

The vet's expectation of her eventual dose being 2-1/2 to 2-3/4 was not meant to be today or even the next few days. He will tell me how much to give this evening if she's up to it. She was doing pretty well on 2-1/2 for over 2 months. She's a good sized cat, used to weigh 20 pounds pre-diabetes weight loss.
 
Definitely agree. Start from scratch at 1 unit every 12 hours - but it is imperative that you test your cat's blood (via ear is easiest) several times per cycle to gather data so you can see whether you need to increase or lower the dose down the line. Do you know how to test on the ear? If not, someone can provide the video for you. It's not the most fun thing in the beginning, but most if not all here have figured out how to make it work.

Lee and Tida (GA) said:
And I would definitely start all over with a dose 1 unit.
Click to expand...
 
The problem is, your vet has zero idea what her insulin needs are. he could test her at the clinic, but vet stress MIGHT raise her bgs in which case he might give her more insulin than she really needs. Plus you need to know trends...ie how high she is prior to shot time AND how low she goes inbetween.

I'm quite concerned with her behaviour....either it is the after effects from the hypo, continuing hypo although not super likely, or really high blood glucose levels as a result of rebound...either way please be vigilant

Jen
 
If your kitty won't sit still for the testing, wrap a towel around her with her head showing.

Here is a beginning hometesting site: http://www.sugarcats.net/sites/harry/bgtest.htm and here is the video: http://www.youtube.com/watch?v=_zE12-4fVn

One of the most important things you can do in the beginning is to hear the ear. Take a thinnish sock, fill it with raw rice and knot it. Put in microwave until very warm but not hot. Warm the ear until very warm but not hot.

Once you get a blood glucose number, you will know immediately whether the problem is too much or too little insulin and the best way to respond.
 
Like the others I'm really going to stress that you learn how to home test, especially the way she is acting right now.

I will give you a very good reason to home test...My diabetic Max was adopted from this board a little over a month ago. When he came to me he was doing very well on 1u of Lantus, but when he relaxed and realized he was finally home, that no one was going to put him in a cage, or ship him anywhere, and got to know us and the rest of our furry kids he went into remission. If I had not been home testing, I wouldn't have a loving, purring kitty on my lap at this very moment...Because if I had just kept giving him what he had been getting, he would have either Hypoed or I would have killed him.

The very first test I ever took on him, he was in my home all of 12 hours. He didn't know me, and I didn't know him. I would have missed early signs of hypo. If I can learn to do it with a cat I had zero relationship with, you can do it with a kitty that already loves and trusts you. Now Max isn't a cat that likes to be restrainted, he will snuggle with you, but don't try to force him to sit still. So at first I wrapped him like a burrito, once we got into a routine and I learned his personality better, I now just call him up on our bed, with all my supplies handy. Give him a few treats and while he is munching, I quickly poke his ear, then test. If he looks like he is going to move, I scoop the blood drop onto my fingernail and test it there.

Mel & Max
 
It is terribly dangerous to decide on a dose based on the cat's BG at the vet!
Stress alone is going to cause those BG values to be totally WRONG.

I have two cats and each reacts differently at the vet office.
My Shadoe goes HIGH at the vet office, but once she gets back home, her BG drops down a great deal.
My Oliver goes LOW at the vet office, almost hypo, but when he gets back to the safety of his home, his numbers go back up. Seriously, I always take high carb food with me when I take him to the vet.

Your vet may be AMAZING for most things, but for diabetes, nope. I don't know what the others would say about dose right now, but one thing is for sure.... you need to get home testing because you are getting scary reactions to the insulin you are giving. For all you know, your cat is fine at home but high at the vet and does not even need much insulin at all.

Home testing first. You have the kit so when you are ready, anyone online can help you. there is always someone around. Once you get a number, post it on here and see what responses you get from others.

As for dose, I would say to go back down to 1u because too little insulin is MUCH safer that too much insulin.

For your shot times, it may be an idea to consider a compromise and aim for 8am/8pm because fluctuations in times will throw your results for a loop too. Insulins for the most part like consistency if at all possible. BUT I don't have any info on Prozinc so the others can tell you how flexible it is with dosing

My vet first told me to give Shadoe 1u once a day, but the good thing about her is that she told me she really did not know because Lantus is not something she knew.

Home testing will get so easy and in no time. My cats sleep through it, and if not around, all I do is call them and they come right over to the test spot.
 
just got Stardust back from the vet about an hour ago. The vet did check glucose (over 350, but not that high considering she's had no insulin) to confirm she was not HG. He gave her some subcutaneous fluids spiked with some minerals (sorry can't remember exactly what) to perk her up, give her some energy etc. He gave us the rest of the bag to give her tomorrow. She went immediately to the water when we got home, then ate a little food. She's been much more active. His advice (as expected) is to not give any insulin if she is not eating or barely eating tonight. but tomorrow give her some insulin proportional to how much she's eating compared to her normal amount. I am to call him (answering service will forward me to him regardless of which vet is on call) if I have any concerns or questions about her behavior tonight/tomorrow and to call Friday and give an update. She's settled down now but is much more alert.

I really wish that I didn't have to go to work and could stay home and monitor her every day, but that is not a possibility in our lives just now. My husband works 2 part time jobs and is gone most of the day (6 am to 9 pm) I work all day and teach classes 2 nights a week. My boss has been okay with my vet appointments etc. but there are things that need doing and I have to do them.

At any rate, I really appreciate everyone's help today. I'll post more later today, but will take the 911 off the message.
 
Please consider that if she was stressed at the vet, her blood glucose levels could be significantly lower than 350. Many cats run 100 points lower, some 200.

To say that you should give insulin proportionate to what she is eating, is, in my humble opinion, irresponsible. You must know what her blood glucose levels are before you give her any more insulin, or you risk another emergency situation. You can't tell what is happening inside her body by observing her or watching what she eats.

You can learn how to home test this afternoon. We can teach you over the internet. Then, before you have to go to work in the morning, you will know exactly how she is doing and how much insulin (if any) to give her.
 
I agree with Sue that you cannot dose based on what she's eaten. My suggestion is to see if you can test tonight. If not, my suggestion would be a token dose tomorrow am of 0.5 to 1.0 units only, no more. She needs some insulin but there is no way to know how much and you absolutely cannot risk overdosing her again. I know this balancing act is tough but it will get easier. You do not need to be home all day, most of us aren't, you just need to get the testing under control. We will help you :)

Jen
 
You don't have to stay home and monitor her all day--just test before shots and whenever else you're able to. I know it seems crazy that the vets could be so off in their recommendation, and that the advice from a bunch of strangers on a message board would be the best advice--but it really is true. I almost killed my cat by listening to one vet in particular. Both my vets I actually really like--they just happened to be really wrong here. And I could have knocked out a month of messing around if I'd just acknowledged that much earlier and stopped taking really, truly bad, erroneous advice I was given.

They're often working from old information derived from old insulins. Lantus doesn't work like Humulin-N. The food relationship isn't as direct as they're making it sound. Your cat could go on a hunger strike all day and still register, say, a 500. It was only after I read all the stickies in the Lantus forum and taking advice from people here that I started to get a grip on the situation.

You're getting a lot of advice and clearly feeling overwhelmed and reasonably so. If I can toss in my pared down 2 cents it would be:

1) Get a meter and test.
2) Start over at 1 unit or even .5.
3) Post here or in the Lantus forum when you have a question.

I didn't add food change because I assume you're already on board with that. Yes, it is new and daunting, but it's totally do-able and becomes second nature. Keep us posted!
 
Evening update - Stardust has been more herself this afternoon, sat in the sun and watched out the window a little while. She has eaten a little wet food that I've offered and has made several trips to the water. It's 2 hours until her usual pm meal and shot, but it will just be the meal today. If she eats some of her usual dry food overnight and eats her breakfast, I'll likely give her 1/2 to 1 unit of her prozinc tomorrow morning.

I truly do appreciate the help and support each of you have given. It has not fallen on deaf ears, stressed ears, but not deaf ones.

My husband and I will be practicing with the meter on ourselves again and tomorrow when we are both home (in between the turkey cooking and the dinner guests) we will give testing her another shot. We could just never get her to bleed when we tried poking her ears and were getting her and us so upset that we're sure her reading would have been high. We gave it a try for about a week after her diagnosis and never once got a reading. One of our former cats would let us do anything to him without a squirm or a scratch. Stardust though has never been completely trusting since we adopted her from the pound several years ago.

I have no doubt that it would be a much more precise and healthy way to handle this, the vet has acknowledged that many people do home testing successfully and would work with us on charting etc., but has not pushed us toward that strategy. He knows that some people/furbabies handle that better than others. He also is very cautious about asking how she acts, eats etc. before giving any advice. The other vet we were forced to see for a couple of weeks seemed to just want to go by the numbers and didn't seem to care how she acted. I'm confident that at some point we'll get her/us used to the meter method, but for today the vet's help is helping. She did well on 2-1/2 units and we will gradually work our way back to that level using behavior, common sense and logic as a guide till we get the meter business worked out. We're getting old and don't adapt as well as we used to.

Is there a chart somewhere that advises what dosage should be given for what readings? (ProZinc) I'm not sure how that would work - activity level of the cat should play into it as well I would think. Stardust is getting older and has never been a particularly active cat.
 
Well Stardust ate about 1/2 her usual amount of canned food, drank some water and resumed her normal spot on the couch. She was anxious for her food (I have my phone set to play a specific tune at food/insulin time) and she marched straight to her usual feeding spot. She's on her way back to normal. No shot tonight though and only a small one at breakfast if she's still improving.

Happy thanksgiving to all.
 
woooo!

there is no chart per se altho some sites have developed one but it needs to be personalized based on your testing data. when starting do not give unless bgs are at 200 or more. track numbers at shot time, called preshot tests. get spotchecks inbetween to determine when insulin kicks in, how low bgs go and at what point and then when does insulin start to wear off. when charted,, the 'picture' is called a curve. based on this info you make dosing decisions.
 
Status
Not open for further replies.
Back
Top