Hypo episode--help please!

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Just tested again. 128. We'll see how much it drops again after this--hopefully not too much but I know we're not out of the woods yet!
 
Up to 139 this time!

Question, though--Spike is still breathing really rapidly and he's also pretty warm. His pawpads and nose are bright pink (they're usually pretty beige) and he's sweating a little. Should I be worried?
 
How rapidly is he breathing? Does it look like he is having a hard time breathing? Would you consider it panting?
Don't suppose you can take his temp?
carl
 
He doesn't seem to be using trouble breathing. His mouth is closed so he's not panting, but he's breathing pretty rapidly. His normal respiration rate is fairly high to begin with. He's mostly just sitting in my room and napping right now and I put the fan facing him.

I can't take his temp. The only thermometer I have is mine, and it's rubber so I don't think it would work well anyway.
 
Next time you test him, check to see what color his gums are.
Just an overall "warm", body or ears is not are very reliable indicator that he might have a fever, which is why I asked about a thermometer. Sometimes rapid breathing can indicate some sort of pain. It could just be he's had a rough day...
Carl
 
carlinsc said:
Next time you test him, check to see what color his gums are.
Just an overall "warm", body or ears is not are very reliable indicator that he might have a fever, which is why I asked about a thermometer. Sometimes rapid breathing can indicate some sort of pain. It could just be he's had a rough day...
Carl
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His gums are...I dunno, gum-colored? Pink, darker around the teeth? Honestly, I'm not sure what to look for.

He's a very talkative cat, and he generally lets me know when he's uncomfortable or in pain. He's being fairly quiet now, so I think he's okay there (but I guess I can never be sure). It could just be the tough night he's had--he's also batting at me and biting me when I get near him, which is VERY unlike him unless he's being playful, which he's not right now.

I have to try to get some sleep, so I'm going to sleep for a bit and set my alarm to check on him a few times in the night. He's been consistently over 100 for more than two hours now, so I'm feeling better about his BG. I'm also leaving some dry food out for him.
 
you can leave him out canned food and it will be good for 12 hrs/ish. mix in a little water and it won't get crusty.

the dry food will send him high and he'll stay high for too long. go ahead and use the canned food and it will be fine.
 
Got it. I left some wet food out instead.

I'm kind of afraid to go to sleep but since I'm sitting here just kind of staring at him at this point, I'm not sure being awake serves much of a point.
 
Kathleen,
If you had said "dull grey", I might have been alarmed. His gums are "normal" - a good sign. Blue or grey would have meant his breathing rapidly indicated he wasn't getting enough oxygen. I was just trying to remove the "bad" things from a mental checklist.
Sounds like he's had enough poking for a while.
Take a cat nap. You did really great tonight! Keep us posted until you have to leave for class.

Carl in SC
 
by the way, i do want to reiterate what sienne said earlier. you were very lucky tonight that this is coming out with a happy ending. it's not your fault, but now that you know, please make sure and test your kitty before every shot and get a mid-cycle test. mid-cycle numbers tell us what the dose needs to be.

knowing what i know now, i don't know how any vet sends a cat out on insulin without having them be hometesting. it scares me to think about.

we'll help you. promise. it's learnable and then you'll know your little one is safe.

hugs!
 
Good morning Kathleen,

I hope you were able to sleep some after all that excitement last night!

One request: Assuming Spike's numbers are OK this morning, could you please go back to the first post in this thread and edit it to change the icon? With a 911, people will keep jumping in to make sure everything is OK.

Second request: PLEASE TEST AND POST! I'm hoping that last night made it obvious to you why the people here are so adamant about home testing, but I say it again because too many people do not learn the lesson even after scary nights like you just had. You've already done the hard part, which is learn how to test :-D , so now all you have to do is keep testing and post here for advice. You need to test before every shot (what we call the "pre-shots", either AMPS or PMPS), and ideally 3-5 more times during the day, most ideally in the +4-+8 range after you shoot, but it's better to have some measurements around the shot than nothing at all on those days where you just can't get mid-cycle measurements.

When I say "here", after you get your spreadsheet up and running, I would suggest that you move over to the Lantus forum for dosing advice. Please read the LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ... sticky to get started.
 
Sam and S'mores said:
Good morning Kathleen,

I hope you were able to sleep some after all that excitement last night!

One request: Assuming Spike's numbers are OK this morning, could you please go back to the first post in this thread and edit it to change the icon? With a 911, people will keep jumping in to make sure everything is OK.

Second request: PLEASE TEST AND POST! I'm hoping that last night made it obvious to you why the people here are so adamant about home testing, but I say it again because too many people do not learn the lesson even after scary nights like you just had. You've already done the hard part, which is learn how to test :-D , so now all you have to do is keep testing and post here for advice. You need to test before every shot (what we call the "pre-shots", either AMPS or PMPS), and ideally 3-5 more times during the day, most ideally in the +4-+8 range after you shoot, but it's better to have some measurements around the shot than nothing at all on those days where you just can't get mid-cycle measurements.

When I say "here", after you get your spreadsheet up and running, I would suggest that you move over to the Lantus forum for dosing advice. Please read the LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ... sticky to get started.
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Icon changed.

Yes, I did get some sleep, thank goodness. Spike got up this morning right as I did and went to his food bowl to eat the food I left out for him before I went to bed (I don't think he ate any last night). He wouldn't let me test his BG when he had just walked up to the bowl, so the first number I was able to get was about 15 minutes after he'd started eating, and it was a 183. Oh, and he's no longer breathing as quickly, and his pawpads and nose are back to a much more normal color. I bet it was the stress.

I don't know if 183 is generally a shootable number or not, but given last night's events and the fact that I won't be here all day, I'm not giving him his shot (unless someone responds otherwise on here before I leave for school). I'll call the vet today and talk to him about it. Like I said, I won't be able to get many numbers today, but I'll try to get as many as I can this week and start posting them.
 
If it were me, I would not shoot this morning.

I you can get even just a measurement 1hr before your normal shot time tonight, and then the pre-shot value, we can make a better decision. If you get measurements at +1, +2 and +3 after shoot, you can get a good idea for where Spike is headed. When I could not get measurements during the day (which is most weekdays), I made sure to get some extra measurements at night. I found the "-1" measurement was very helpful to me on those low data days. When I could measure on the weekend, I made sure to get a full cycle (measurements every 2 hours or so over 12+ hours).

Unfortunately, a few measurements spread out over the week really does not help much. Insulin is a hormone, and Spike's body is relearning how to control that hormone. Those swings happen over a few hours, not over days, so you really need to get clusters of data from a single "cycle".

Please post tonight so that we can help.

And be happy. Those low "green" numbers as we call them mean that Spike's pancreas is healing, and may be able to take over completely eventually! Published studies have show remission rates as high as 85%, so this is not a pipe dream at all (if you follow the protocols here).
 
Good a.m. Kathleen and wonderful Spike!!!! goood boy and mommy too!
Glad to know that his numbers are up and he is feeling better. Keep us posted. My Sugar Bean went OTJ within a month, it is possible!
 
I'm not checking his numbers before each shot. As of a few days ago, he was on 2U BID, and when he went to the vet for a bloodwork recheck a few days ago, he was in the 40s-50s range (I can't remember exactly) at 6 hours post-shot. At that point his dose was changed to 1U BID, which I started Friday evening.
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I found this above in one of your previous posts (Aug 14th). I have to say, this is the SCARIEST THING I'VE EVER HEARD OF a vet say. I don't understand how vets think they can safely treat with insulin based on occational readings at the vet, but just sending you home after a VERY LOW reading in the vets office with a random change in dose is just horifying to me. Please be careful and use your own judgement with whatever the vet tells you going forward. Most vets just don't have enough experience with FD to give good cronic advice. They are a lifesaver in emergency situations, but inbetween, they can sometimes do more damage than good.
 
kbean said:
I don't know if 183 is generally a shootable number or not, but given last night's events and the fact that I won't be here all day, I'm not giving him his shot .
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Newbies are advised not to give any insulin if the bg is under 200.

Please start testing bgs before giving the insulin, even if you are running late for something. Blindly giving insulin without knowing what the bg is can result in a hypo, like you just experienced, or worse.
 
squeem3 said:
If the bg is over 200, then you can give the 1 unit, or even half a unit if you're really cautious.
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I would not give 1u tonight if BG is over 200. Since he just had a pretty crazy hypo incident on 1u, it is too much insulin. If numbers are over 200, and they likely will be (when cats experience a hypo episode like this their numbers usually go very high afterwards because their livers dump glucose into their blood. This usually clears within 24hours, sometimes a little longer), I would give .5u of insulin, maybe .75u at most. Since you haven't been testing regularly, we don't really know what his dose should be at, so I think it would be safer to drop to .5u and hold it for a few days to see how he does on it. That means getting some mid-cycle tests in. If he's going into remission, the dose may need to be lowered rapidly. If he's not, it can always be raised back up to .75u once your tests indicate the need for that much insulin.

Most cats do need to be weaned off insulin if they are going into remission, rather than suddenly removing it. Given the dangerous advice you've received from your vet already (being in the 40s-50s at the vet is INSANE, because numbers are not only inflated because of vet stress, but they also use a meter calibrated for felines, which means those numbers are actually lower than you think--a 50 on a human meter is about an 80 on one calibrated for cats), I am worried that they will advise you to stop his insulin completely. This is not recommended because doing so could send him slowly climbing into high numbers again and force you to start treatment all over again. You need to shoot lower doses (.5u, then .25u-.1u) for a bit to help the numbers hold.

Discontinuing insulin may seem very tempting, especially when you're very busy and the vet is recommending it. However, this is not in Spike's best interest.

I would really urge you to set up a spreadsheet. The link is here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0 (if the spreadsheet won't copy, the workaround is here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130)

Please also review the dosing protocol for Lantus: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. There are many very experienced people in the Lantus forum that can help guide you into remission. My vet did not give good dosing advice, so I learned how to dose correctly there, instead. And regarding testing--I work two jobs and go to grad school, and my vet was telling me that it wasn't necessary to test daily, so I was very lax with it in the beginning. That was until I did my own research and realized that the 80+% remission rate was ONLY attainable by following the protocol, and that the protocol was also the only safe way to administer insulin. It seems like a pain to get those tests in the beginning, but the payoff of doing it the right way now means getting your cat off insulin and then you only have to test once every few weeks. If your schedule is anything like mine, then getting to this point sooner than later is a goal to work towards. And the added bonus is having a healthy and safe kitty.

I hope to see you over in the Lantus forum!
 
I'll test him tonight around 7:00 Central Time and let you guys know what the number is. Regardless, it sounds like I probably shouldn't shoot tonight (or if I do, a smaller amount).

I'm still waiting for the vet to call me back, so we'll see what he says. If he recommends going cold turkey, I'll probably try to wean Spike off of it instead. How quickly would that generally be done? Is it sort of standardized, or generally just going by the cat's BG levels?

In terms of home testing, I can definitely start doing that. However, on weekdays there's really no way for me to get numbers during the day. I can definitely do pre-shot AM and PM numbers and up to about +4 hours post-shot in the evening, but that's all I'll be home for. Weekends are obviously much more flexible. Should that suffice?

- Kathleen
 
Whatever you can do will have to be enough. I was successful with exactly the schedule you listed above.

As for "weaning off", the people here generally follow a protocol called the "Tight Regulation" protocol, which uses a set of well-defined rules to adjust dose up or down as needed, including adjusting down to zero if the cat is ready.

In general, we try to avoid "canned" posts, but here is the relevant section from my Quick Start Guide:

 
kbean said:
I'll test him tonight around 7:00 Central Time and let you guys know what the number is. Regardless, it sounds like I probably shouldn't shoot tonight (or if I do, a smaller amount).

I'm still waiting for the vet to call me back, so we'll see what he says. If he recommends going cold turkey, I'll probably try to wean Spike off of it instead. How quickly would that generally be done? Is it sort of standardized, or generally just going by the cat's BG levels?

In terms of home testing, I can definitely start doing that. However, on weekdays there's really no way for me to get numbers during the day. I can definitely do pre-shot AM and PM numbers and up to about +4 hours post-shot in the evening, but that's all I'll be home for. Weekends are obviously much more flexible. Should that suffice?

- Kathleen
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Generally the dose is adjusted by the cat's BG levels. The mid-cycle tests determine what the dose should be, which is why it's important to get one every day. I work 10 hour days about an hour away from where I live, so it was impossible for me to get a mid-cycle test in during the day. So what I did instead was test before Bandit's shot in the morning (7am), before his shot at night (7pm), and then 6 hours into the PM cycle (1am). This meant setting an alarm, getting up real quick to test, and going right back to bed. Yes, it's a bit of a pain to do this every night, but the reward is getting your cat safely off insulin and into remission. And Bandit was so worth the minor incovenience. The preshot tests tell you whether or not it's safe to shoot insulin, but that daily mid-cycle test is also vital--it is what determines the dose. I also did a curve (a test every two hours for an entire cycle) once a week on either Sat. or Sun. morning when I was off work to get a bigger picture of what was going on.

Basically what you want to do is gather data right now--each test you get is a piece of that data. The more data you have, the more informed and better your decisions are about dose adjustments. This will give you enough control to keep Spike's BG in a normal range for as much of the day as possible. The longer Spike is in a normal BG range, the more his Pancreas can heal. Once his Pancreas heals, that is when remission occurs.

I really understand how difficult it can be to get enough tests in with a full plate. But once it becomes routine, you really don't mind it. I got to the point with the 1am tests where I was literally doing them in my sleep...thank goodness meters save the test number because my zombie self never cold have recorded the number right. :-D
 
I can probably handle getting up around 1:30 to test if needed!

I just got home and tested Spike's BG and it's 41. His last dose was yesterday AM, although he also hasn't eaten since this morning.The vet did call me back and recommended discontinuing the Lantus. I know that you guys recommend not to go cold turkey, and I was planning on doing it gradually (I haven't had time to read all of those posts that you recommended yet). However, I'm assuming his numbers need to go up more than this for me to give him any Lantus at all.

- Kathleen
 
Kathleen,
Did he eat okay at dinnertime? I wouldn't panic about the 41 provided the next test has him a little bit higher. He hasn't had insulin for 36 hours or so?

Carl
 
Sorry, I had to put my little ones to bed.

First, I think you should start a new post, with a new title like "36 hours of Lantus, BG=41, Advice?" You might go ahead and post it in the Lantus forum instead of Health.

I agree with Carl. At 36 hours, there should only be a very small amount of Lantus left in Spike's system, so you don't want to overreact and stress his newly recovered pancreas with lots of sugar.

That said, there is still some Lantus in him, and if he is very insulin sensitive right now, it could be enough to cause a problem. It seems like he may naturally drop to low numbers in the evenings, so a little Lantus might push him over the edge again.

Any chance you picked up some gravy or other HC foods today?

Assuming the answer is no. I would suggest that you feed him some normal LC food, but don't let him stuff himself in case you need to spike Spike with karo in an hours. Test in 30-60 minutes. Lather, rinse, repeat.

So long as he is not symptomatic, at this point off Lantus, I would not start Karo until he was down to 35 or lower, or if any symptoms show up: Read the symptoms here and here

I hope this is really the begining of your OTJ trial (14 days makes it official), but don't count on it. Many cats need to go back on a little insulin after a few days to finish the healing process.BTW, check out S'mores's great video!

I need to go to sleep soon. My littlest is getting ear tubes very early tomorrow :sad:
 
carlinsc said:
Kathleen,
Did he eat okay at dinnertime? I wouldn't panic about the 41 provided the next test has him a little bit higher. He hasn't had insulin for 36 hours or so?

Carl
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Yep, he ate just fine. I'll test him again in a bit.
Sam and S'mores said:
Sorry, I had to put my little ones to bed.

First, I think you should start a new post, with a new title like "36 hours of Lantus, BG=41, Advice?" You might go ahead and post it in the Lantus forum instead of Health.

I agree with Carl. At 36 hours, there should only be a very small amount of Lantus left in Spike's system, so you don't want to overreact and stress his newly recovered pancreas with lots of sugar.

That said, there is still some Lantus in him, and if he is very insulin sensitive right now, it could be enough to cause a problem. It seems like he may naturally drop to low numbers in the evenings, so a little Lantus might push him over the edge again.

Any chance you picked up some gravy or other HC foods today?

Assuming the answer is no. I would suggest that you feed him some normal LC food, but don't let him stuff himself in case you need to spike Spike with karo in an hours. Test in 30-60 minutes. Lather, rinse, repeat.

I need to go to sleep soon. My littlest is getting ear tubes very early tomorrow :sad:
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Wasn't able to get any HC food today, but will try to get some tomorrow.

Good luck with the ear tubes! I've babysat a lot of kids who got them and they were all SO much happier once they had them!
 
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