Hypoglycemia Episode :(

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kellyandloki

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Hi all, Loki and I haven't been on the FMDB board in years, but now, I find myself back here hoping for some guidance. At approximately 1:15am this morning I heard an odd swishing sound continously for several minutes. I was in bed, trying to sleep and thought Loki was playing with hsi kicker or licking himself (he's overweight and a loud licker). I thought nothing of it. The sounds continued. After about 10 minutes I went to investigate and found Loki under my computer desk chasing his tail. The swishing sound was him rubbing past the wood of the desk each turn. I thought he was chasing his tail... I laughed. He didn't even notice me trying to get his attention or talking to him- he was obsessed.

I got down and pulled him from under the desk and he sat down for a minute and looked at me like "what?". Something was off. I told him to follow me; I wanted to see how he walked. He seemed to lean to the right a little. I wondered if maybe his fur was matted (because of his overweight issues he cannot clean his fur past his shoulders). Thought maybe he had an itch. I brushed him, he laid there accepting. He then stood back up and started to "chase his tail" again. Then he started yowling. I picked him up, aware of the meaning of the yowls. I brought him to his litter box and set him down; he got out and pooped on the floor, then pressed his face against the bathroom cabinet for balance. When he was done he ran a little bit, then collapsed then got up and walked drunkenly to the chair and pressed his face into the wall next to the chair. This was not good.

I called the ER vet and told them to expect me shortly.

Loki was diganosed with acute pancreatitus in 2002, and has been on Lantus insulin since 2005. For the last year or so he has been getting 7 units twice daily. I used to test his glucose every single time I fed him prior to giving insulin. But he became regulated at 7 and I became confident. I still did curves for a few months, then stopped testing him. We both paid for my mistake this morning.

Loki's BG was 60 when I took him to the ER. He was mostly blind at that time and stumbling. He still yowled, but mostly panted. They fed him, gave him an IV, and some sedatives. I went home. At 9:15am I transferred him to his regular doctor and they did blood tests and took an xray of his belly, etc. He ate. His eyesight came back mostly, but his eyes are still "cloudy" in the light of the vet's instruments. He cannot walk.

His doctor seems pretty confident that it was a pancreatitus flare-up and things will get better. I don't feel confident tonight, watching poor Loki try to live, wondering what tomorrow will bring. He can barely stand enough to try to take a step, but he manages to sort of scoot, rather loudly, thump thump thump, as he makes his way across the floor. He is unable to sit upright to eat his food so I put it on a plate for him- he just kind of melts into a pile of mush while eating. I caught him with his face resting on the rim of his water bowl, his chin in the water. He's going to drown himself.

I don't know what to do. They gave me Buprenorphine for any pain. He is sleeping now. When he's awake, he looks coherent, though tired. He twitches now in his sleep. He wants to get up, to move, to walk, but it is so difficult. He manages a step or two then collapses... tried again a couple minutes later. He cannot make it into the litterbox. I fear he will begin to "go" wherever he may be, but not yet- he still tries, but I have to lift him and hold him in the litter box.

I am so confused right now, so worried for him. Is it the drugs he's been on today? Twice on sedatives, now twice or three times on pain meds. Could the hypoglycemia still be affecting his ability to walk? Will he get better? I just checked his BG while he slept and he's at 293.

Anyone have any history with a hypoglycemic episode, and if so, did your kitty recover? I'm so scared. :(

Thanks everyone.
Kelly and Loki
 
Hi Kelly (and Loki)
I have never dealt directly with a hypo incident, so I can't answer that question for you. First thing, sweety, take a few deep breaths. You were probably told that the first day you came here way back when, but the advice still gets doled out every day and every night.
You know also from those days, that once you're hear, it's forever, and you are never alone. I am very sure that there are folks still here from back then, and sure that they'll drop in, maybe not till the morning....

It sounds like he's still doped up. The bupe and the sedatives are probably still doing that. I've had kitties that were sedated and sent home, and it at least 12-18 hours till they were "right".
He wasn't comatose or semi-comatose when you found him, so it didn't go as far as it may have. Thank god you heard that noise! Don't beat yourself up about not testing. Right now, it is what it is, and looking back and "what-ifs" are just going to drive you crazy. Think about now, and tomorrow, and don't even go beyond then.

He's out of the woods if his BG is back up in the 200s. Do you have test strips that are still good? Not to make light of this, but I think he's earned a dose reduction? You good with being able to test him in the AM? Do you remember any of the names of the folks who were in Lantus last time around? Can you PM any of them? They don't sleep I think! :smile: They are possibly in the lantus forum right now,

I think I would see if Loki will spend the night in the room with you, just so you can keep an eye or an ear on him. If you don't see anyone online now, check back in the AM. I can cross post in Lantus to get someone's attention for you?

Above all, thank you for posting this. There have been two kitties who had bad hypos in the past few weeks that didn't make it. They were in worse shape when their poor beans found them. But everyone needs to be reminded that things like this can happen, even years down the road.

Please keep us posted. And try to have a peace filled night, okay?
Did they give you fluids for the p-titis, or just pain meds?
Carl in SC
 
kellyandloki said:
Loki was diganosed with acute pancreatitus in 2002, and has been on Lantus insulin since 2005. For the last year or so he has been getting 7 units twice daily. I used to test his glucose every single time I fed him prior to giving insulin. But he became regulated at 7 and I became confident. I still did curves for a few months, then stopped testing him. We both paid for my mistake this morning.


7 units of any insulin is an awfully HUGE dose for most diabetic cats. How did your vet reach a dose of 7 units twice a day?

What are you feeding Loki? Dry food could be one reason why 7 units of insulin was needed. Dry food is high in carbs which keeps blood glucose levels too high, much like how sugar keeps a Human diabetic's levels too high. The right diet is important. For cats, that is low carb canned food or raw food. Don't worry about diet right now, though. The most important thing is right now is for Loki to recover.

Loki's BG was 60 when I took him to the ER. He was mostly blind at that time and stumbling. He still yowled, but mostly panted. They fed him, gave him an IV, and some sedatives. I went home. At 9:15am I transferred him to his regular doctor and they did blood tests and took an xray of his belly, etc. He ate. His eyesight came back mostly, but his eyes are still "cloudy" in the light of the vet's instruments. He cannot walk.


60 isn't that low. But if the reading was done at the ER, then a bit of stress could have increased the bg a bit.


They gave me Buprenorphine for any pain. He is sleeping now. When he's awake, he looks coherent, though tired. He twitches now in his sleep. He wants to get up, to move, to walk, but it is so difficult. He manages a step or two then collapses... tried again a couple minutes later. He cannot make it into the litterbox. I fear he will begin to "go" wherever he may be, but not yet- he still tries, but I have to lift him and hold him in the litter box.

I am so confused right now, so worried for him. Is it the drugs he's been on today? Twice on sedatives, now twice or three times on pain meds. Could the hypoglycemia still be affecting his ability to walk? Will he get better? I just checked his BG while he slept and he's at 293.

Did the ER test Loki for ketones? Ketones can cause a condition called diabetic ketoacidosis. You can test for ketones yourself. Buy KetoDiastix from the pharmacy and dip a strip into a fresh sample of cat urine. Match the color change to the chart on the bottle. Anything more than a trace needs immediate vet treatment.


Anyone have any history with a hypoglycemic episode, and if so, did your kitty recover? I'm so scared. :(


My diabetic only had mild hypo episodes which were easily treated at home with high carb gravy canned food and lots of blood glucose testing.

There are people here who have experienced much more serious hypo episodes in which their cat needed to be brought to the ER. You can try the search function to find some of those posts: http://felinediabetes.com/FDMB/search.php

I hope Loki will recover ((Hugs))

Were you ever on the old FDMB? I found a profile for someone with your name and cat's name there: http://www.felinediabetes.com/phorum5/profile.php?16,2425
 
Hi Kelly,
I found your post from 2008 with a listing of your test results, and since you had switched to a good low carb wet food, fancy feast I think, if you have been giving 7u twice a day since that time, you may want to start testing regularly again....

The drop to 60 is not that low.... my non diabetic has tested at 42 and 58 with most numbers in the 40s. I hope that Loki is just shocked by getting such a low number when his others seem to have been high all the tiime.

If Loki has still been getting numbers in the 300s and 400s on 7u of Lantus twice a day, you may want to have Loki tested for acromegaly and IAA... Talk to your vet about it as these 2 conditions would account for the high numbers on such a large dose, and the drop to 60 is something that may be seen in a cat with IAA.

I hope Loki comes around nicely.... please post how Loki is doing as soon as you are able.

Gayle and Shadoe&Oliver

eta: http://www.felinediabetes.com/phorum5/r ... ?8,1222352
 
Kelly,

PJ should be along shortly to this discussion and she can better tell you what happened with our Cagney and the major overdose by a vet that started us on the sugar kitty trail over 5 years ago. Suffice to say when she arrived with Cagney at the ER, the vet there noted in her records that she was "essentially a dead kitty." More than 5 years later, Cagney still gets a good giggle out of that story.

You've got plenty of hope and support here.
 
7u BID is a lot of insulin for a cat on low carb diet.

Have you ever had Loki tested for Acromegaly? The test is for IGF-1 levels and only one lab in the U.S. runs this test. (Mich State Univ Vet Research Lab)

If Loki has this condition, it would perhaps explain some of the symptoms.

At work now - I don't have much time to post. Will come back this evening.
 
May be a moot point if he's an acro kitty, but Cuddles mostly recovered from a severe hypo. I found her limp in the morning & was probably like that all night. I gave her syrup, and she started acting better within minutes.. but took some fluids out of the bag, and she had a seizure. Finally found out that whenever she would hear that crinkling noise, it would throw her into a seizure. I would be REALLY careful with bags & such.. but noticed over time, that sensitivity started to disappear. She always got some weird look in her eyes, and her head would twitch when she heard that... But she never had another seizure thankfully. Hope yiur kitty is back to himself soon.. although it sounds like be either needs less food, or a bit of testing since he sounds too big for his own good.
 
Unfortunately, PJ is having trouble accessing FDMB so she's asked me to respond on her behalf.

She says this doesn't sound anything like a pancreatitis attack, and having dealt with that alongside PJ, I agree. Pancreatitis is incredibly painful. Cats with pancreatitis (Cagney's been there) are generally lethargic. They'll hang out in a meatloaf position and will usually hide rather than respond to affection. They also usually don't eat and they'll vomit to the point where all that comes up is white foam.

Running around like a crazy kitty just isn't indicative of pancreatitis so far as I know. PJ said it sounds like something else is going on. People have already been talking about acro and that's definitely something to explore.

On the hypo side, I can tell you that Cagney bounced back from a nearly unreadably low BG in the beginning (and low body temp and coma) and we've gotten her to rally from numbers in the 30s at home. We were lucky to catch those low numbers since she really wasn't acting differently than usual. That being said, Cagney also doesn't react like a normal cat to, well, anything including insulin so your mileage may, and probably will, vary as far as reactions are concerned. Still, coming back up from a 60 BG is very doable.
 
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