Hypoglycemia concerns

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Sarah and Simba

Sarah and Simba

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Hi,

Simba's about to start insulin and I'm concerned because I work all day and live alone.

Does a hypoglycemic episode typically come on suddenly and right after injection?

I couldn't find the answer to the specific question (probably because it's 101 - a given - but I'm still in kindergarten) so would really appreciate knowing the whut whuts.

I found some info on delayed-onset hypoglycemia, but it seems it's caused by excersice or exertion - not a concern for him at this point.

Sarah.
 
If you are feeling worried, Sarah, I would start with one unit instead of the 2 your vet suggested. You can just say you are really nervous about starting this whole thing and you would like to start low and give more insulin if she needs it later.

Usually (although every cat is different) Lantus reaches its lowest point around +6 or so. The lowest point (or nadir) would be when you would see a low number and be nervous about hypo. Lantus can last longer than other insulins so the hypo can last longer than the usual 12 hour cycle.

The best way to not worry is to test before each shot and at nadir. And to start at a lower dose. And be prepared: viewtopic.php?f=28&t=15887 Print out the hypo sheet and put it on the refrigerator so you have it handy. Get the things in the kit like higher carb food, syrup etc. Very few home tested cats hypo. Most cats we see here who hypo have been giving a larger dose and are not testing or just started and see a low number.
 
Unfortunately, there is really no rule b/c every cat is different. This is the beauty of testing - you know b4 you shoot what her number is and if its safe to shoot. Maybe on your days off you can get some tests at mid cycle and a few other random times so that you know how Simba is responding to the insulin. Starting with a lower dose and collecting as much data as your schedule allows are the best ways to protect your kitty.
 
Sarah said:
Does a hypoglycemic episode typically come on suddenly and right after injection?
Click to expand...


No. Insulin usually takes a few hours to "kick in" and start lowering blood glucose levels. It's not going to drop your cat's bgs like 5 minutes after you give the injection. How long it takes for the insulin to kick in depends on the type of insulin, the dose, your cat, how much food your cat has eaten, and various other factors.

If you are worried, start at a very low dose of 0.5 units twice a day. And be sure to learn how to test your cat's blood glucose levels at home. By testing before giving each injection, you know if it safe to give the insulin or not. Newbies should not give any insulin if the bg is under 200 mg/dl. And if your cat hypos, you can test to see how low the bg is and what action you should take (home care with small frequent high carb food and frequent testing or an immediate trip to the ER if symptoms are severe or are not improving).

Be sure to print out the hypo reference sheet so you know what symptoms are typical and how to treat: viewtopic.php?f=14&t=1122 And keep these items readily available to use: viewtopic.php?f=14&t=2354
 
tysm everybody. I feel like I'm wading in jello here, there's just so much information and I'm, apparently, not equipped to handle it all at once, so I really appreciate all the helpful answers! Does anyone happen to know where the info sheet on what all the +1 +2 +3 +4 etc means? I found one yesterday on this site, but I can't seem to find it again...
 
HI Sarah,
Here is the link to the "Glossary". It is in the Health links. Or at the "top" of the page in the forum.
viewtopic.php?f=14&t=1124

I also was overwhelmed at the beginning so I copied everything into word docs and printed them out later.

Good luck with your little one, you are in the right place.
 
thank you's.

It looks like I might not be starting insulin just yet. I just got this email from my vet:

"This is where we are:
If he is not showing signs of diabetes as per your observations, ((note from Sarah: He hasn't been drinking as much as he was)) there is a possibility, although very slim, that his pancreas has recovered after discontinuing prednisolone. The other possibility is that he has developed ketosis,as per your observations that he is not well, which changes the condition from uncomplicated diabetes to complicated diabetes. This is a very serious life threatening condition. I need to know where he stands so that I can treat appropirately.

Now, before I can start him on insulin, I absolutely need:
1.blood tests including thyroid, liver and kidney function tests
2.Urinalysis, to detect infection [which causes insulin resistence and poor control of the diabetic patient], kidney function, and equally or more important, ketosis."

I take him in today at 2.

For some reason the spreadsheet won't load for me. I've seen it now in 'preview' though, thank you. I"ll try to at least print it.
 
Re the spreadsheet: We have been having some problems but I thought they were fixed. Try one more time - click on the spreadsheet itself when it comes up in Goggle. Wait at least several minutes for it to completely load. Then pick Use this Template and wait again. It has been loading really slowly.

Both the US and World versions worked for me this am, but they are both loading very slowly.
 
after clicking the clink for the template, it takes about 10 seconds to load.
After clicking 'use template', the window goes white - and stays that way. The status bar reads 'done'.
Using the latest version of firefox
 
Hi Sarah,

I read your first post, what is crusty paw? Is that better now?

When Simba was taken off the steroids was it a gradual reduction? Like 2 pills each day for three days, then 1 pill each day for a few days, then 1 every other day?

It won't hurt to run the bloodwork and get the urinalysis, in fact I try to keep up with senior panels when I can afford them.

What did you tell the vet that made him/her suspect ketones?

The +1, +2,+3, that is how we tell people what time it is on the insulin schedule. For instance, I shoot my cats at 7:30 AM and PM. I would put the AM PS (morning preshot number) in the PS column and what dose I gave next to that. If I test Kiki's blood sugar in 2 hours, I would place that BG (blood glucose number) in the column noted as +2, it's much easier than saying 9:30AM and because people on this board are all over the world, time differences would only confuse. By using +4 to mean four hours after the shot, it's easier to follow. You'll also find for yourself, if you have to give insulin, thinking in plus certain hours makes it easier to understand how your kitty is reacting to insulin.

I hope that the FD is transient, steroid induced and now gone, but if not, that's okay too. A few of mine have gone off insulin, a few have not, the love is still the same :)

Best of luck for your appointment today.
 
Thanks Sue, was able to download from the last link you posted :D

Hi Tucker's mom! Thanks for saying hullo :)
- Crusty Paw is when litter sticks in between the toes and to the pads due to the increased glucose in the urine
- We actually went with a really low pred dose: 1 pill one time a day. We tried to get him to 1/2 pill but he started coughing again. Took him back to 1 pill a day and he was doing just fine - till now.
- Vet is suspecting ketones because his water intake dropped dramatically - I have the litter out of the box now and just waiting for him to pee so I can dip my first stick.

He was doing just fine on the pred. The reasons he's ON pred is because has a broken tooth that led to sinus and lung/breathing/pnuemonia issues - so he was on prednisone and antibiotics. We wanted to get that situation under control before considering anesthetic to pull the tooth - incidentally, he still has the tooth so he's still on antibiotics.

Then suddenly he stopped eating. He's done this before, and it was always constipation but I thought I'd bring him in just in case. She thought it might be related to the tooth, but after feeling him up decided it was likely constipation. I got that under control with lactulose and at a recheck appointment, casually pointed out the 'crusty paw', saying that I'd switched to clumping litter recently and she said it could be diabetes. glucometre test confirmed he was 'hi'.

The vet wouldn't have caught it - she was on her way out the door - and I don't know what made me show her his toes.
 
Sarah said:
- Crusty Paw is when litter sticks in between the toes and to the pads due to the increased glucose in the urine
Click to expand...

Some FDMB people call that "cement booties" :lol:
 
Once his lungs are stable I'd really push to get that tooth out as it can really complicate a lot of things

Not sure why your vet links decreased water intake with ketones...doesn't follow for me??
 
I did not know about the cement boots glucose link. Interesting. I had a very senior kitty, my sweet little man Henry who I adopted at the age of 16. He was on steroids but never got FD thankfully. He did however have cement booties every day. Still remember the tap tap tap on the hardwood floors whenever my little man entered the room :)

Get the bloodwork done, but like Jen, I would not associate decreased water intake with Ketones, tired, weakness or just acting wonky I might.

If your cat wont use the box without litter you could try putting the litter back in and covering with saran wrap. I've found my cats may scrunch it up by I do usually get a nice pool to dip the stick in.
 
saran wrap! Very clever. I think he did his business already by the time I switched out boxes though. Vet might have to take control of the urine collection.

tuckers mom said:
like Jen, I would not associate decreased water intake with Ketones, tired, weakness or just acting wonky I might..
Click to expand...
That sounds like him - but he's been like that since the onset of constipation.

Oh, I forgot to mention vestibular disease. He's had two attacks, but none since starting him on ear drops.


Jen & Squeak said:
Once his lungs are stable I'd really push to get that tooth out as it can really complicate a lot of things
Click to expand...

He was stabalized *with* pred... so, it's sort of up in the air right now. The vet was more concerned with his ability to withstand anesthetic.
 
Does he have any past issues with anaesthesia? if not, then I'd go for it. With the caveat that his blood pressure is monitored throughout, that he is on fluids, and a pulse oximeter if they have one. Squeak is pretty touchy with surgery ( he tries to die if they give him opiates/narcotics) but he needs regular dentals so we do all we can to reduce his risks.
 
\ When it comes to anesthesia, I'm not going to **** around. lol. She's a surgeon, I trust her judgement on surgical matters.
 
Saran wrap used to work for my Himalayan but not for the ones I have now. They thought the litter box was out of order with the plastic wrap in there. I found out that one of my kitties would peepee in a small plastic cup that i buried in the corner. I buried several about halfway in the litter all around the area that he usually aimed for. Worked wonders for him. He HATES having to give a sample to the vet.

Whenever I had to give my diabetic shots (he's OTJ now), I always felt better giving him 4 smaller meals a day. I would get timer feeders so that he would have something while i was at work. I would wake up at night to make sure that he had something in the middle of the night.
 
lol! Also an ingenious solution! Simba's so clumsy I'm betting he'd drop his foot in the half-buried bottle!
I'm going to see how he does with an empty litter box, he doesn't scratch much at litter anyhow. We'll see.
I'm tending to agree with you on the feedings - he'll only eat a little at a time anyway.
The vet eased some of my concerns, saying we'll regulate his dosage based on what he's already doing anyhow.

The vet today confirmed he was ketonic +3
She did a Toronto & Lantus injection to bring him down. Pre-shot, he was off the scale. After three hours he was at 17.3 (311.7). She said she measured it again and it was at 14.7 but it wasn't in the documents she sent home with me.

Thanks for all your help everyone :D

I'll be doing a few glucose tests tonight and ... I just realized the vet forgot to give me back my insulin. CRAP! The office is closed. What do I do? skip his next dose I guess. DAMMIT.
 
Yes, I think you will have to skip the shot. Does your vet have an emergency number? One of our many sayings is "Better too high for a day than too low for a minute." (?) Hope that qualifies tonight.

You can shred up some newspaper for the litter box. I saw someone else used lentils?
 
Lentils!? you guys are awesome... and so is my vet! She got my 'oh no, the insulin!' message and landed on my doorstep, insulin in-hand an hour later. phew.
I also got my spreadsheet working :) Things are looking up... everything but his values! YAY!
Emotional roller coaster, this is.
Thanks again for the support, kind words and clever ideas everybody.
Sarah.
 
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