hypo episode!!!

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colleen & smoke

Member Since 2013
hi everyone,

just had a bit of scare as Smoke had a hypo episode. he is on one unit of humulin (i know, i know- more on that later!) he received his normal dose at around 7:45 AM and seemed a bit off at 12:00. His test revealed "LO" and I was able to get him up to 63, then 82, then 112 within the hour (corn syrup and gravy food). He is supposed to get an evening dose around 4 PM, but should i skip this dose? Also, he started on 1/2 unit and I'm thinking we need to drop back down? He has been on insulin for about 2 1/2 weeks.

hope this is enough info for now, i'm still recovering myself!
 
Colleen,

I don't know your history so I'm just going to say quickly that hypo can increase insulin sensitivity so it may be prudent to skip the next shot. In any event it is evident that the dose is too high...

Just going to have a look through your previous posts...

Eliz
 
Hi Colleen,

Oh gosh, forgot to say earlier; Well done! I know hypo is seriously scary, but you coped brilliantly!
Is Smoke totally recovered now?

Did you get a pre-shot blood glucose number before giving this morning's shot? (And if so, what was it?)

And is Smoke still on Prednisolone? Or is he off the steroids now?

Eliz
 
Hi Eliz!

I will definitely skip the next shot. His pre-shot level was 246, which is fairly typical for him. He seems to be okay right now, taking a little nap. I actually just did a test and he was in the high 200s. His numbers rarely exceed 300, which is why there was an initial hesitation to start the insulin.

We are in the process of weening him of the pred, so right now he gets it every 5 days.

Thank you for the support! I'm just glad i had everything within easy reach when it happened!
 
colleen & smoke said:
We are in the process of weening him of the pred, so right now he gets it every 5 days.

Thank you for the support! I'm just glad i had everything within easy reach when it happened!

You did really well. You showed great presence of mind. It can be hard even to string a thought together when you suddenly find your cat in low numbers! But you were obviously prepared for this eventuality. Excellent stuff!

It may be that the Humulin is dropping Smoke's blood glucose too steeply; and maybe a gentler and longer lasting insulin would suit him better. Is there any particular reason why you started out with Humulin?
 
I so appreciate that; thank you.

However, I am a bit concerned right now. I just did a test about 1/2 hour ago and he was at 496!!!! Never been that high before, ever! Obviously it's due to the syrup and gravy food (i might have over compensated on that one, but better too high than low, right?) He is acting a little lethargic however it is very hot here today. Also, no food or water since the episode, but i did get him up and he has gone to the bathroom twice.

Is he okay? Is this just the after effects of such an event?? I am worried!
 
colleen & smoke said:
I so appreciate that; thank you.

However, I am a bit concerned right now. I just did a test about 1/2 hour ago and he was at 496!!!! Never been that high before, ever! Obviously it's due to the syrup and gravy food (i might have over compensated on that one, but better too high than low, right?) He is acting a little lethargic however it is very hot here today. Also, no food or water since the episode, but i did get him up and he has gone to the bathroom twice.

Is he okay? Is this just the after effects of such an event?? I am worried!

1) he 'bounced' - he got much lower than he normally does and his body released compensatory hormones to release stored sugar.
2) yes, aftermath of giving high carb.

If you want to shoot, be cautious - ex 0.25 to 0.5 units.
 
Okay, got it- that makes sense.

I think i'll skip the dose tonight and just keep testing him every so often. The lethargy is concerning, still. I just moved him into a cooler room with his brothers, so maybe that will help a bit. He still seems dazed.....
 
just checked him- at 238. i feel that is a safe number for him to go to bed with. he has food and water with him.
should i check on him during the night?
 
colleen & smoke said:
just checked him- at 238. i feel that is a safe number for him to go to bed with. he has food and water with him.
should i check on him during the night?

I expect you've gone to bed now (and am guessing you really need some sleep after all that).

It's good to see that he's dropped out of those high numbers. (That was quick too; I thought maybe he'd be up there for longer!)
Was Smoke only feeling off when his numbers were high?
Is he OK now? Fully recovered?

Do update us when you can.
Sleep well... I-)

Eliz
 
Phew! All seems much much better this morning. He was alert and drinking some more water. His pre shot number was 236, which is typical for him, so I went through with his morning dose.

I am curious to know what caused the hypo episode, though. I'm thinking he might not have eaten as much as usual when I gave him the shot. Also, it's much hotter than usual- could that have something to do with it?

Aside from all that, he's doing quite well and I could not have done this without your help!

Thank you!!
 
Hi Colleen,

colleen & smoke said:
Phew! All seems much much better this morning.
... His pre shot number was 236, which is typical for him, so I went through with his morning dose.
I'm relieved to hear that Smoke is OK (and that you are too!).
Did you reduce the insulin dose?

colleen & smoke said:
...I am curious to know what caused the hypo episode, though.
I'm thinking he might not have eaten as much as usual when I gave him the shot.
Also, it's much hotter than usual- could that have something to do with it?
What blood glucose level does Smoke normally drop to during the cycle?
Have you caught any other low-ish numbers?

It's hard to say why the hypo happened.
Maybe he's got better at utilising insulin and the dose is simply too high now.
Or maybe he's producing more insulin of his own.
Or maybe he ate less (or threw up his food?).

As to blood glucose numbers changing when the weather gets hot; yes, this does actually happen with my own cat. My cat's blood glucose levels are very weather/season dependent, and they get lower as the weather gets hotter in the summer.
Cats are quite likely to eat less when the weather is hot. But they may also not drink as much as they need to, and any degree of dehydration might affect blood glucose levels too..?

Eliz
 
Eliz- thank you so much for following up and for the useful information. The lowest numbers I have seen him during the cycle is 82. He's typically around 110.

But, guess what- this morning we had another hypo incident. I caught it earlier than yesterday, but I think I have made up my mind to try another go with feeding him exclusively DM (wet). Back in September/October when he was eating it, he was down to the 90s all by himself! The only reason we stopped was because it was getting difficult to separate him and his brothers during feeding (we have been feeding them all Friskie's Pate/FF Classics). However, with two days in a row of hypo, I think I gave the insulin a good try and it's just not for him.

This morning he was 236 and I even gave him 1/2 unit instead of one. I caught the hypo around 10:20, roughly 2 hours after his shot. I'm really not sure what's going on, but instead of chancing it, I'd rather stick to a strict D/M diet. He's been on the Humulin for about 3 weeks, and the reason he was on it was due to his lower numbers (never exceeding 300) and because he was initially only on a small dose in the morning. Also, we were hoping the insulin would help him gain weight, but maybe the D/M will, too (he needs to gain at least 2 lbs....he's gotten teeny tiny!)

I know D/M isn't the greatest, but at this point, I feel it's the safest and if it worked before, hopefully it can do so again.

Please, any feedback and advice would be so appreciated right now. You all are a wealth of information!
 
Humulin has a diluent; your vet can obtain that so you can dilute it to a lower concentration.
It comes as U-100 and it is very difficult to measure doses smaller than 0.5 accurately, although we routinely eyeball 0.25 unit doses.
By diluting it to a U-50 concentration, the half unit mark would now indicate a quarter unit.
And it could be diluted lower, too, if needed.
 
Before giving up on insulin maybe try a better one? Humulin is really not a very good insulin for cats. It drops them fast and that adds to the risk of hypos. A longer lasting insulin will be gentler, may bring him down flatter all day long, and allow him to heal and get his pancreas working properly again. The other insulins are more expensive, but work better with a cat's metabolism.
 
Hi everyone,

Thank you for the suggestions- I didn't not know that there was such a thing as a diluent. That is good information to have.

I do have an update: I switched Smoke back to wet D/M exclusively, and just like the last time in the fall, it works beautifully. Within the 2nd day, he was already down. He has not been over 150 on any of his bg readings (much less, actually!) and I feel it is the safer option for him.

HOWEVER, he remains sooooo thin and doesn't seem to be gaining weight. I know it's only been a week, but I am worried. I have begun supplementing the food with some boiled chicken, but any advice would be much appreciated at this point. He NEEDS to gain weight!
 
Small frequent meals are how vets will advise an underweight cat gain weight. Also use a low carb, high calorie food - check Cat Info for the food list.

Are you home testing the glucose? If his numbers are elevated, he may not be able to use all of what he eats.
 
He gets fed several times throughout the day.

Yes, I do home test and he's been consistently under 150 throughout the day, with an occasional small spike after eating.
 
I already gave you what I know - small, frequent meals of calorie dense food - ex low carb kitten food, higher fat foods like Wellness Turkey & Giblet.

Time & regulation of the diabetes is going to help the weight gain.

Just put on the "patience pants". Deb has some she can show you in numerous colors!
 
If you are still not giving Smoke any insulin, and that is what your signature says, that could be a factor in Smoke not being able to gain much weight. He may need some insulin to help him process his food properly. Without the right amount of insulin, the cat is literally slowly starving.

I realize that Smoke hypos easily, but perhaps only a drop or two of insulin would help him to gain weight.

I know if I wanted my sugardude Wink to gain a bit more weight, I'd crumble the freeze dried chicken treats on his food because those get him to eat better. I'd also need to feed him at least 5 meals a day instead of his current 4 meals. He'll only eat so much before his tummy is full and he walks away from the food dish.

Do either of those ideas work for you?

Oh yes, almost forgot to send the patience pants your way.
 

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I will put on those pants- thank you!

In regards to the insulin, he was getting 1/2 unit twice a day up until a few weeks ago. It would be very difficult to give him any less than that! The 1/2 unit is barely a drop to begin with. However, now he is only on the D/M because it regulates him much better than the insulin was. His numbers are lower and much more consistent on the DM wet food alone.

Are you saying that even with the good numbers on the DM he is still not regulated with the insulin?

I will continue with the chicken and he eats many many times during the day. He's up to eating a full can per day!
 
To measure doses smaller than 0.5 units, practice the drop method as follows:
Take a syringe and fill with a colored liquid.
Gradually squeeze out 1 drop at a time of equal sized drops.
It helps to carefully twist the plunger as you press.
Repeat until you can consistently squeeze out the same number of equal sized drops.
Use that info to adjust very small doses.
 
Okay, thank you for the tip! I will keep that in mind.

But, Smoke is not on insulin right now because his numbers are so good with the DM. So, my question is, will he not gain weight without insulin even if he is controlled on the dm?
 
It'll depend on how much insulin his body can produce to use the food. If it matches up, he may gain weight. If it is insufficient, he could lose more weight. Get a digital baby scale and weigh him weekly. You'll find out if his weight is changing that way.
 
Got it! I have been weighing him about every other week. He's been on the DM exclusively for about 2 weeks now and he hasn't gained any....i think he lost an ounce or 2 :(

Maybe it will just take more time, but i was hoping 2 weeks would have led to something
 
A couple ounces could be the difference of before vs after a bowel movement, so he may be stable.
 
Are you saying that even with the good numbers on the DM he is still not regulated with the insulin?

We can't tell, because you don't have a spreadsheet set up for Smoke and linked into your signature. We can't see how good his BG levels are or how well regulated he is.

Should i maybe weigh him at certain times each time?
Sure, consistency is a good thing.

I weigh my 3 kitties twice a week and try to do the weigh-ins the same time each day. That time is in the morning before breakfast. The reason I'm weighing everyone twice a week is because when I first was fostering little Dancer from the shelter, they were concerned with her health and weight and requested twice weekly weight checks. I've simply kept up that routine and weigh all the kitties so none of them feel left out. ;-) They all get a little freeze dried treat for being so cooperative and that helps.

A couple of times during weigh in sessions, one kitty has used the litter box after their weight check so I've taken the opportunity to get a post void check. It's usually anywhere between 2-4 ounces. I end up sort of averaging the weights for the week and adjust food intake up or down as needed. For instance, Wink right now is down about 3 ounces from normal, so he's getting a bit more food and some extra freeze dried chicken treats.

Once a week weight checks should be fine for most kitties.

It does take time for a kitty to gain back some weight. Wink dropped about 12.3 pounds to 10.2 pounds in about 8 weeks and went OTJ where he's been for the last 15 months. I thought that rapid weight loss was much, much too fast but neither the shelter or the vets were concerned with his rapid weight loss. Even now a year later, he's only up to about 10.9 pounds. He'll gain a few ounces and lose it, gain 4-5 ounces and lose 2, gain a bit and lose a bit over and over again. I'm happy if I can keep his weight stable and will give him extra food if I think he's losing too much. It's hard though, because he'll only eat so much food at one time before he's full and walks away. Those freeze dried chicken treats crumbled on top of his food sure do help to tempt him to eat the last little bits. I also found that taking him into a separate room to finish the last little bits of food and locking out my piglet kitty Monet helps a great deal. Wink no longer is any good a pushing a big bully like Monet out of the way.

My feeling is that even though Wink is OTJ and is getting good BG readings, he is missing a little bit of nutrition from the food and needs a bit of extra food to maintain his weight. I've been adding some extra pure protein like a tablespoon of cooked chicken or pork to his meals a couple of times a week but will increase that to every day for a while to see how he does. I'm concerned with the loss of muscle mass in his hind quarters and think the extra protein intake may help him gain back some of that lost muscle mass. He's somewhere in the 11-13 year age range where that muscle mass loss is pretty common in cats.

I hope that some of the ideas I'm using for Wink will help you out too.
 
Hi Deb,

Thank you, thank you for all the weight info. I'll keep you all posted, of course.

I have added Smoke's SS! The link is in my signature and you can take a look and let me know what you think.

If you look at my previous posts, you'll see the reason we waited so long for the insulin was because his numbers only increased during the afternoons for a very short time. Talk about difficult to control!

The SS starts in September 2013. The 2014 for the first few months is an obvious error.

If you have any questions, pleassseee ask!! I'm here to learn (and hopefully, help- eventually!)
 
Hi Colleen!

I see you noted a diet change on 5/22/14 on your SS, switching completely to the Purina DM canned food. The Purina DM dry is almost 14% carbs whereas the Purina DM wet is around 3%. That diet change is likely helping Smoke to get those lower BG readings in the last couple of weeks.

I see that you've stopped giving any insulin since 5/15. My guess is that the Humulin N is just too scary for you to use, dropping Smoke from the mid-200's down to hypo territory pretty quickly.

Is there any chance you would be able to get one of the longer duration, gentler acting insulins for Smoke? Either Prozinc, Lantus or Levimir would be better. I know of savings programs for the Lantus pens and the Levimir pens. I do not know of any savings program for Prozinc. You would need a prescription from your vet for the new insulin. If Smoke were my cat, I'd try to get him on a better insulin.

Alternatively, let's see how Smoke continues to do with his diet change, and if you could be as vigilant as possible and keep him out of his brothers higher carb food, we may continue to see some lower numbers.

I'm not happy to see those yellow numbers at mid-day. Doesn't make sense to me why the BG levels are going up so much, 90-120 points, even without any insulin.

Is Smoke being fed again at mid-day? Could he be getting into his brother's food more often then you think? Any other "contraband" type food?
 
Hi Deb!

Yes, we haven't used and dry DM since the fall. He responds much better to the wet.

You're exactly right with the insulin. It was just too scary. So, in regards to a gentler insulin and your next topic: the mid-day spikes.

He eats in the afternoon, but same stuff. Plus, if he's tested, it's always at least 1-2 hours after he's eaten. We are very diligent about him getting into any "illicit" food items, so it's not that.

The afternoon numbers have been the problem since day one. Even since his initial diagnosis, it was always that 3 hour spike from around 12 PM-3PM that made our vet hesitant about giving insulin in the first place. I have done my own 12 hour curve at home two times now and it's always the same thing. When Smoke spent the day at the vet and they did their own curve---same thing! It's been the biggest mystery of all. So, the general consensus is that if he has good numbers all day except those few hours, it is incredibly hard to get a grip on.

Does this make sense? Let me know if you need anymore info
 
Maybe get a timed feeder such as the PetSafe 5 and feed smaller mini meals more often. That may level out the food spikes.

So if you're feeding 3 or 4 times a day, switch to 6, including overnight.
 
Yes, since he is trying to gain weight, Smoke eats several times throughout the day. I can't leave food out during the night because I can't separate him and his brothers. Plus, none of them are much interested in eating past 10 PM. First feeding is around 5:30 AM
 
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