HYPOGLYCEMIC - NEED HELP PLEASE

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At least he's not dipping down as much now. Hold off on the honey and test again in 15 minutes.

>>> Do you have a feeding syringe?

ETA: Just absorbed your comment about his dislike of the syringe.

>>> Would you be able to get some of the DM wet food into him by hand feeding?

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I already gave him the honey, so I'll hold off after this next check.

I have a 10cc syringe. Is that big enough? I believe that's what one of the bets gave me.
 
I just went to go check him and he's eating the gravy from the dog's food on his own... Going to make fresh pate and see what happens. I may wait until 0500 to check him again.
 
(HUMAN METER READINGS)

AMPS: 280 - Dose: 2.0IU PZI

PMPS:
1702 - 269 - 1 can I/D (100%); zofran; 2 units pvi [ED: PZI insulin???]; thirsty;
2141 - 34 - attempt to syringe feed honey unsuccessful; 1/2 can DM given immediately after + drop honey on gums
2216 - 51 - (15min after eating ~30% of DM canned and rubbing a drop of honey on his lip/gums); sm handful Blue Wilderness Mature given / ate few pieces immed bfe 2216 check; 1/2 cup DM kibble replaced with 1 cup Blue Wilderness kibble in kitchen and 1/2 cup in bedroom;
2230 - 50 - honey given
2247 - 48 - honey given
2300 - 60 - honey given
2317 - 47 - honey given
2330 Hi [ED: possible duff strip?] - honey given
2332 - 68 - honey given
2335 - 73 - honey given
0000 - 67 - honey given
0034 - 74 - honey given
0055 - 59 - honey given
0115 - 48 - honey given
0131 - 42 - honey given
0145 - 46 - honey given
0202 - 39 - honey given
0230 - 55 - honey given

0249 - 60 - PM+9
0305 - 46 - PM+9.25 - gave sm amt gravy from dog food + honey
0315 - 48 - ???
0333 - 59 - PM+10 - honey given after [OTHER TESTS AT THIS TIME: 0330 - 98 (error?); 0331 - 61 - working off lowest result as safety precaution]
0350 - 54
0400 - 57
0418 - 73 - [LOWEST READING USED. Other tests at this time: 0415 - 109 (suspect?); 0416 - 78; 0417 - 73.]
0430 50 - honey given (Zofran @ c. 0500) Ringo ate a little dog food gravy c. 10 mins after this.

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His 0500 glucose was 41. So, I opened a fresh can of DM pate and added chicken broth and honey (ew!) to it. Warmed it up and made sure it was soupy enough to put in a syringe. We got the better part of 6cc in him before he got loose. Should I check him at 0515 or wait until 0530 since we just got done?
 
Great job on getting some of the DM wet and honey syringed!

Given that he dipped to 41 after the last dose of honey I'd test now to be on the safe side. (Will take a little bit for the DM/honey mixture to get into his system.)

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(HUMAN METER READINGS)

AMPS: 280 - Dose: 2.0IU PZI

PMPS:
1702 - 269 - 1 can I/D (100%); zofran;
1730 (latest) 2 units pvi [ED: PZI insulin???]; thirsty;
2141 - 34 - attempt to syringe feed honey unsuccessful; 1/2 can DM given immediately after + drop honey on gums
2216 - 51 - (15min after eating ~30% of DM canned and rubbing a drop of honey on his lip/gums); sm handful Blue Wilderness Mature given / ate few pieces immed bfr 2216 check; 1/2 cup DM kibble replaced with 1 cup Blue Wilderness kibble in kitchen and 1/2 cup in bedroom;
2230 - 50 - honey given
2247 - 48 - honey given
2300 - 60 - honey given
2317 - 47 - honey given
2332 - 68 - honey given [ADDITIONAL READING AT THIS TIME: 2330 Hi (Possible duff test strip?)]
2335 - 73 - honey given
0000 - 67 - honey given
0034 - 74 - honey given
0055 - 59 - honey given
0115 - 48 - honey given
0131 - 42 - honey given
0145 - 46 - honey given
0202 - 39 - honey given
0230 - 55 - honey given

0249 - 60 - PM+9.25
0305 - 46 - PM+9.50 - gave sm amt gravy from dog food + honey
0315 - 48 - ???
0333 - 59 - PM+10 - honey given after [OTHER TESTS AT THIS TIME: 0330 - 98 (suspect?); 0331 - 61. Working off lowest result as safety precaution]
0350 - 54
0400 - 57
0418 - 73 - [LOWEST READING USED. Other tests at this time: 0415 - 109 (suspect?); 0416 - 78; 0417 - 73.]
0430 - 50 - honey given; Ringo ate a little dog food gravy c. 10 mins after this.
0500 - 41 - Zofran 2mg; syringe fed c. 6cc warmed DM wet food mixed with chicken broth & honey.
0515 - 65
0530 - 52 - +12 hrs after last insulin dose [SKIPPING SHOT. NO FURTHER INSULIN GIVEN AT THIS TIME.]

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I think it's a smart move taking Ringo to the vets. Although he's currently above 50 most of the time on the human meter it's taking a lot of intervention to keep him there and you're at +12 hours since the last insulin dose.

Try to syringe a little more of the wet DM/honey if you can (use a towel to wrap him in a 'kitty burrito', maybe?). If he won't take the syringe feed, try to see if he will eat some from a raised dish (now that he's had the Zofran he might eat a bit on his own).

Try to see if he will eat some of the Blue Wilderness kibble dipped in honey.

Bring the honey with you and give him some more at intervals during the journey to the vets to be on the safe side.

I suggest asking the vet about giving an Rx for cyproheptadine to use instead of the mirtazapine, because you can give it more often than the mirtazapine and it might better aid Ringo to have a more consistent appetite (c. 1/8 of a 4mg tablet q8hrs - ETA: for 10lb cat). (Safety note: cyproheptadine is contraindicated in cats with high blood pressure, glaucoma, or with liver problems.)


Mogs
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Might be an idea to print out one of my posts with the most up-to-date running BG results/feeding info to give to the vets.

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Also, when you're out today be sure to pick up a supply of cat food with gravy for your hypo kit (e.g. Fancy Feast Gravy Lovers). It might be an idea to also get some plain meat 'n' broth only baby food (I think Beechnut is one that's OK - make sure there's no onion, garlic or other dodgy ingredients). It may be a good stand-by to have in the house in case you're having trouble getting Ringo to eat anything. Some Temptations high carb treats would be another helpful addition for the hypo toolkit. (We know they're high carb!)

And don't forget to replenish your supply of test strips for the meter! :) (It has been a busy night.)


Mogs
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I really need the SITREPs in order to keep track, Kris. Because of the PTSD my 'working memory' just doesn't function - at all - so it's impossible for me to hold information in my head any more. It's so bad that if someone is talking to me I can't even fill up a glass of water and take in what they're saying at the same time (a sorry state to be in for a former project manager). :(


Mogs
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Critter Mom said:
I really need the SITREPs in order to keep track, Kris. Because of the PTSD my 'working memory' just doesn't function - at all - so it's impossible for me to hold information in my head any more. It's so bad that if someone is talking to me I can't even fill up a glass of water and take in what they're saying at the same time (a sorry state to be in for a former project manager). :(


Mogs
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I understand, Mogs. :bighug: Even without those issues, it's hard to sort out key info when it's in a massive block of text.
 
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Tritt3180 said:
He had been off his zofran for 3 days before I got more. The vet closest to us ordered it online, but it isn't here yet. His other vet farther away had it in stock and we got some, but not until he vomited at home on 1/10.
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If you get stuck with an out-of-stock situation like this again, I'd suggest ringing round local pharmacies to check if they've got any generic ondansetron in stock. If yes, your vet could give you a written Rx and you could fill it at the regular pharmacy straight away (even if it's just for enough doses to tide you over till the vets get it back in stock again).


Mogs
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Tritt3180 said:
His 0500 glucose was 41. So, I opened a fresh can of DM pate and added chicken broth and honey (ew!) to it. Warmed it up and made sure it was soupy enough to put in a syringe. We got the better part of 6cc in him before he got loose. Should I check him at 0515 or wait until 0530 since we just got done?
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make sure the chicken broth has no onions cooked in it
 
Kris & Teasel said:
I agree! It's so scary for the advice giver when there's little back and forth with the owner. It leaves us imagining the worst.
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Tell me about it. There have been a couple of occasions in the past when I was on hypo watch where I ended up yelling, "PLEEEEEEEEZE TELL ME YOUR CAT'S BG AND FEED IT NOOOOOOOW!!!!" at the screen ( :oops: ) only to be greeted by a roaring silence. Not fun ...


Mogs
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So thankful for all the help in what could have been a very sad event!!:bighug::cat:

I brought Ringo to the vet and had to leave him there so I could go to work. I just received a call from the vet with good news so far...

His blood sugar is now 125, so back to normal. He has gained a pound, and the Dr thinks it may be time to lower his long acting insulin dose. She is sending a fructosamine level and that will determine what we do from here. I am SO RELIEVED!! Wasn't sure if I'd get to see my baby again, and I'll get to take him home after work.

Note... COFFEE!!:coffee::coffee::smuggrin:

Again, thank you, MOGS, for all your help. I see now things I can update and change to be better prepared if this happens again. You're a lifesaver... Literally!
 
Not at all. I was just the cheerleader; you did all the saving! :D

That was a seriously prolonged run of low numbers but you kept your head and handled it incredibly well. As I mentioned above, I'd like to thank you for keeping all the updates coming because that really helps members here to help you (and does wonders for our blood pressure! ;) ).

Glad to hear that Ringo's back in safer numbers and holding steady at the vets. I'd be very interested to find out how his BG was in the first few hours at the vets (to determine whether there might have been any carryover of last night's dose into this morning's (skipped) cycle; it would be very valuable data to secure for future reference).

Tritt3180 said:
the Dr thinks it may be time to lower his long acting insulin dose
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No thinking and no maybes required here. Ringo absolutely needs to have his dose lowered. I know that he didn't eat enough but even so, based on what his levels were like during this cycle, there is a real possibility that Ringo's pancreas may have also been getting in on the act.

>> Is there any chance you could post the link to Ringo's spreadsheet here in this thread so we can have a look-see?

I'd also suggest that, if possible with your schedule, maybe you could give Ringo his Zofran dose with a water chaser about an hour or so before you're due to give him his pre-insulin feed? Perhaps it might help him to eat more at injection time?

>> Any joy with an Rx for cyproheptadine?

If you do get the cypro Rx you could then try administering that dose about 30 minutes before injection time (again with a syringed water chaser to wash the pill down properly), or at injection time itself. Even if it doesn't kick in right at injection time, it might help Ringo to eat a bit of extra food in the early part of the cycle.

You're a phenomenal cat mama! Enjoy your well-deserved (and probably desperately-needed) coffee! :D

:bighug:


Mogs
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Tritt3180 said:
if this happens again
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Fingers and paws crossed it won't but, for future reference, if Ringo is on the low side and you need to post for help on Feline Health be sure to set the '911' prefix against the thread title to let members know you need urgent assistance. Also, if ever Feline Health is quiet in such a situation go to the Lantus and Levemir ISG board and post a 911 there too so as to 'get more eyes' on your situation. (There's a lot of traffic on that board but many of the contributors don't visit the FH board very much.)


Mogs
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Tritt3180 said:
So thankful for all the help in what could have been a very sad event!!:bighug::cat:
I brought Ringo to the vet and had to leave him there so I could go to work. I just received a call from the vet with good news so far...
His blood sugar is now 125, so back to normal. He has gained a pound, and the Dr thinks it may be time to lower his long acting insulin dose. She is sending a fructosamine level and that will determine what we do from here. I am SO RELIEVED!! Wasn't sure if I'd get to see my baby again, and I'll get to take him home after work.
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Wow, what a night @Tritt3180 ! I went through that for 3 cycles in a row starting Fri night & it was so stressful. You did great! And I'm glad @Critter Mom was around to help & provide support. This group is so amazing & helpful!

Because you're home testing, I don't think you need to have the Fructosamine test done. A reduction is definitely called for after what you & Ringo just went through. And you have the data on your spreadsheet so the Frustosamine test isn't going to give any more info that what you already have. If your vet has already requested it that's fine but for future reference you can save money by not doing that test.
 
Turns out Ringo's steroid shot for his asthma the culprit behind all this (i had a feeling it was). He got it about 3.5 weeks ago, and that would explain the quick drop in his glucose. The frictosamine level was 369(?). According to the lab, a reading <500 is "excellent control." She thinks Ringo will be able to make a full recovery and as long as he's on the diabetic food he can see remission.
 
A-ha! It helps so much to find the reason(s) behind a low run.

So glad that Ringo is safe and well after all the high jinks overnight. What has your vet advised about insulin dosing in light of these discoveries?


Mogs
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Well handled by everyone here. Burning the night oil too - very stressful.

That is a good point about the steroid shot. Leo gets daily prednisolone shots, and each one raises his BG. I compensate for that by an increased AM dose, then a normal PM dose.
 
Critter Mom said:
@Tritt3180 -

Just checking in to ask how Ringo's doing. How did things go with the vets (esp. re insulin dose)?


Mogs
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Sorry I didn't respond sooner. i didn't get a notification of your post...

His glucose came up and she changed his insulin similar to 1unit if needed q12•. So for, he's doing well. No insulin since the morning of the 19th. :-) He had three nights this past week where he vomited around the same time each night. Each time 3 times. I got up and have him his famotidine, and he was fine all day. I've been wanting to give it to him before bed, but haven't been able to between his zofran and getting him to eat a little before bedtime. Lots of blue's on his spreadsheet.
 
@Tritt3180 -

Ta for the update. Glad to hear Ringo's doing OK.

Any chance you might post a link to his spreadsheet in this thread (link in your signature isn't working).

Does giving the famotidine before his pre-bed snack put him off his grub?


Mogs
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Critter Mom said:
@Tritt3180 -

Ta for the update. Glad to hear Ringo's doing OK.

Any chance you might post a link to his spreadsheet in this thread (link in your signature isn't working).

Does giving the famotidine before his pre-bed snack put him off his grub?


Mogs
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I am still having problems since I have not made it to a location where I can use a computer to link my spreadsheet. I can pay a picture, though, it's not as good as the link.

I may try to give just the famotidine at night and zofran in the morning. I did that yesterday, and he vomited during the day yesterday, and not at night last night. I gave him zofran today and he hasn't vomited yet. Idk... My schedule is cramped at night so I didn't want to give both meds and his dinner close together so everything digests properly - and he's usually pretty hungry when I get home to feed him. Plus, giving any medication seems like such a traumatic event for him.... If he's eating, I don't want to interrupt him for medication and have him associate it with something negative. I'll try to change things up this weekend and see what results follow.
 
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