Hypoglycemic Scare/Help!!

[GeeshyCat]

Hi everyone..My first time here and looking around, could use a little help.
I have a senior cat who is on 4 units of Vetsulin twice a day. He's usually on the higher side and readings of 600 are typical for him when he's high.
I noticed he was having a hard time walking yesterday about four hours after getting his shot. Shortly after, he started convulsing on the floor and making loud meows. I took him into the emergency vet because I panicked and didn't know what to do. The doctor looked at him and said based on the way he was laying (arms locked) he probably had a clot in his brain but they can run tests and xrays or I could put him down. He never once mentioned low blood sugar and being new to this, it didn't even register. I opted to put him down. While in the room with him, I couldn't do it. He slept in my arms and it didn't feel right so I told them I'd like to take him home. Once we returned home, he got up and ate and seemed as fine as an old cat could be. Stupid us didn't check his glucose and gave him his insulin. Four hours later he was convulsing again. I didn't think he'd make it through the night. We put sugar and syrup on his gums and I woke up and there he was, meowing, walking around and purring, his typical self.

I called the emergency vet and they said to skip his morning shot (he was around 321). Now that his night shot is rolling around, I'm terrified.

He's eaten some. Do I stick with the same dose at this point? He's high, around 676 but these are his typical high numbers. I'm so scared and feel so guilty I didn't catch on that his sugars were so low, I was basically killing him by giving him the insulin. Does anyone have any tips? I called another emergency vet and they said they are not allowed to advise me on changing the dose but to give him his insulin.

Thanks!

 

[Tuxedo Mom]

Are you home testing?

How long ago was your kitty diagnosed?

4 units twice a day is a high dose for any kitty, unless they have been diagnosed with a high dose condition. Vetsulin tends to be faster acting and can bring glucose numbers down very quickly, especially in the first 2-4 hours after the shot.

It really sounds like he had two serious hypo events which could have been very deadly. Shame on the ER vet for not checking the glucose levels on a diabetic kitty being given insulin!!!

If you are home testing...please say you are...you need to test before each shot. Make sure your kitty has not eaten any food for at least 2 hours before you do the prehot test. Then you must make sure he has eaten a good meal and wait 30 minutes after eating before giving the shot. Then you should be doing another reading at +2 hours after the shot and again at +4 hours after the shot...even earlier if the numbers are dropping too quickly.

Without any more information I would suggest starting at 1 unit and doing some regular testing. If your kitty drops too low, the body's natural counter-regulatory defences will release stored glucose which will cause the number to rise up much higher. This doe NOT mean that he needs more insulin.

There is much more information you should read, but I just wanted to get this out there quickly if you are about to do a shot.

 

[Kris & Teasel]

Excellent advice from Tuxedo Mom. Your kitty's insulin dose is likely far too high.

 

[GeeshyCat]

I'm SO mad at the ER for not even suggesting it. I take the blame too, I should know more but that's their job

He was diagnosed about three months ago. I am home testing with an Alphatrak. My vet said I don't need to do it every time so honestly, I haven't been. I will be much more cautious moving forward. Do you have any suggestions for a different monitor? I'm almost out of test strips and wow, they're expensive! I wasted about seven today because he doesn't bleed much and once you put them in, they go bad.

I checked his sugars at about 7-730 and that's when he was around 676. He just ate about 20 minutes ago. If I give him one unit and he remains high, are there any immediate threatening side effects like the low end produced?

I'm sorry to be all scatterbrained! Thank you so much for replying!

Edit: He is also on a 9-930 am/pm schedule. Is it imperative to test every couple hours as long as he's diabetic or only at first? I work and am not always around so it's hard to keep up with him constantly.

 

[Chris & China (GA)]

Do you have any suggestions for a different monitor?

If you're in the US, your local WalMart will have the Relion Confirm or Micro meter....they take the smallest sample size and the strips are affordable ($36/100)....Lots of us here use them!

Make sure his ear is warm before you poke.....a little sock with some rice in it (microwave for 10-20 seconds) or a pill bottle filled with warm water are both good ways to warm the ear before testing. Test the temperature against your wrist like you would a baby bottle

If I give him one unit and he remains high, are there any immediate threatening side effects like the low end produced?

High numbers take time to do damage....it's the low ones that can kill quickly.....if he runs high, you should be testing for ketones though. You don't want to risk a DKA on top of everything else....not only are they very expensive to treat, it's not always successful. Here are some Urine Testing Tips . You can get urine ketone test strips at WalMart too

4U is a terribly high dose, especially for a cat that's as newly diagnosed as yours is. Vetsulin also isn't a great insulin for cats in the first place...it's much better for dogs. Some people here have used it successfully, but there are better insulins for cats available like Lantus, Levemir or ProZinc

I totally agree that you should back down his dose and be testing before every shot and if at all possible, at least test somewhere around 4-6 hours afterwards and always before you go to bed at night.

 

[GeeshyCat]

If you're in the US, your local WalMart will have the Relion Confirm or Micro meter....they take the smallest sample size and the strips are affordable ($36/100)....Lots of us here use them!

4U is a terribly high dose, especially for a cat that's as newly diagnosed as yours is. Vetsulin also isn't a great insulin for cats in the first place...it's much better for dogs. Some people here have used it successfully, but there are better insulins for cats available like Lantus, Levemir or ProZinc

Do you know what size lancets are best? We've been doing his paw but is the ear better?

Would it be worth asking for a different insulin? I don't really know what I'm talking about yet so I have no clue what to say to my vet.

And thank you everyone. You guys are amazing. Yesterday was horrible and anything to help my little guy is so appreciated. I wish I found this board months ago!

 

[Kris & Teasel]

Do you know what size lancets are best? We've been doing his paw but is the ear better?

Would it be worth asking for a different insulin? I don't really know what I'm talking about yet so I have no clue what to say to my vet.

And thank you everyone. You guys are amazing. Yesterday was horrible and anything to help my little guy is so appreciated. I wish I found this board months ago!

We usually suggest 26 - 28 gauge lancets at the start because they're more likely to give a good blood drop than the finer 30 -31 gauge. Most of us find the ear is easier. If the paw works for you, use it.

If you have a supply of Vetsulin at home you could continue with it. There are people here who have used it successfully. To be safe, though, we'd recommend a restart at no more than 1 unit twice a day along with a structured BG home testing routine. ProZinc, Lantus and Levemir tend to be better insulins for cats. You might want to read the info stickies about them in their respective forums.

 

[GeeshyCat]

I'm back...Last time, I swear.

His hind legs are also struggling...I believe that's the neuropathy? I read on here something about b-12. I tried the search but it says it's too short/error. Can anyone link me to a good information source regarding it?
He's also on Hills W/D prescription canned food. He's not enjoying it anymore (but scarfed down a can of fancy feast in a minute) so is it ok to switch to the fancy feast permanently?

 

[Chris & China (GA)]

What most of us recommend for the neuropathy is Zobaline for Cats ...it's not an "instant fix", but it can work miracles in time, but the most important thing is to get the blood glucose under control.

He's also on Hills W/D prescription canned food. He's not enjoying it anymore (but scarfed down a can of fancy feast in a minute) so is it ok to switch to the fancy feast permanently?

Hills W/D is very high carb and (to put it mildly) garbage food. The Fancy Feast Classics are much lower in carbs and the ingredients are actually better....BUT, if you're giving insulin, you need to be home testing while you transition the food. Dropping the carbs can significantly decrease the amount of insulin he needs!!

The entire "prescription" food industry is a scam....there's absolutely nothing in the food to require a "prescription" and if you check the ingredients, they aren't any better (and usually worse) that what you can get at your local grocery store.

 

[Nan & Amber (GA)]

You've gotten a ton of good advice already, I'm just popping in to say, thank goodness you trusted your instincts, and well done to figure out what was going on with the hypoglycemia, all on your own!!!!! I know that ER vets have a tough job-- they see all kinds of animals in all kinds of crises, often with very little idea of the background and history, but the performance of that first ER was just shameful. Good for you for not taking their terrible (and irrevocable) advice.

 

[Catdaddy87]

Sorry you had to go through that! Glad your cat is ok. Stick to the advice here and you and your cat will do great. This board has been a massive help. I don't think I could manage Sam's diabetes without it!

 

[Olive & Paula]

I'm back...Last time, I swear.?

Oh sweetie, do not let this be your last time. It takes strength, patience and some ranting to raise a diabetic cat. You have the entire world here to help you through all of it.

The 3rd best thing to do (after home testing and spreadsheet) is to make this site part of your daily routine. Do not try to do this alone until you know what's happening with your cat.

Something not mentioned above. If you are using Vetsulin, it's best to feed 30 minutes before giving insulin. You want food in his system before Vetsulin starts to take effect.

 

[JanetNJ]

OMG how scary!!! If I were you I would lower back to 1 unit, test preshot, 4-5 hours past shot, and preshots again. do curves (every 2 hours for 12 hours whenever you can). The ear is the easiest place for most of us to test. Alphatrak is a fantastic meter.. it's just that the strips are expensive. If you don't mind the cost then keep using it. If the cost of testing 4-6 times a day makes it a bad choice then switch to the relion micro or confirm.

In my signiture I show how I test my cat cc's ear.

 

[GeeshyCat]

I have no words to express how grateful I am for everyone's help. My vet called me today because he received the paperwork from the ER vet and when I explained what they said, he yelled are you kidding me?! He was not pleased.

I've been doing 1 unit since last night. I forgot to write his preshot number but it was in the 600s, but he also had no insulin that morning. I set an alarm for 1 am and he was down to 295. At 8:30 am, he was in the 500s. He received his shot at 10:30 this morning by my dad and I don't believe he took his blood cause his eyes are terrible and he can't see well. A little after 9 pm tonight, he was 326. I've now fed him and given him his shot. I'm trying to move his shot time down to 7 or 8 to better fit my new work schedule, also allowing more time to test him at night without going to bed worrying. Are these numbers acceptable with the 1 unit dosage? My vet said I can bring him in for a curve if I want but I know that his numbers will be higher from being there. He also said I can do it at home but I'm a little confused with the new monitor I bought.

I picked up the Relion Micro today. I had one Alphatrak test strip left so I did a comparison and got two different numbers, which I expected from what I've been reading but I'm not sure if it's too much of a gap. The Relion said he was at 222 while the Alphatrak said 326. How exactly do I work with the numbers from the Relion to get the most accurate results?

Thank you again. This has been so overwhelming and I'm happy to have found a place with such nice, helpful people.

 

[Chris & China (GA)]

Are these numbers acceptable with the 1 unit dosage?

For now, with the recent hypo, he's in the middle of a "bounce".....bounces happen when they 1. drop too low, 2. drop too fast or 3. drop into numbers their body just isn't used to anymore.

The liver releases stored sugars and hormones to bring them back up to where the body is "used to" being....but it's not very exact! All Mr. Liver cares about is getting them higher....He doesn't much care how much higher!!

Bounces can take up to 6 cycles (3 days) to clear so you don't want to worry too much about the numbers while those errant hormones are still working their way out.

The Relion said he was at 222 while the Alphatrak said 326

That's pretty typical.....there's no direct comparison you can do between a human meter and a pet meter. The only "official" numbers we have is for the "Time to act" number....That's under 50 on a human meter and under 68 on a pet meter. As the numbers get higher, there will be bigger and bigger differences, but what's important to know is what are "good numbers".....too high is too high no matter which meter you're using.

Normal blood glucose for cats is 50-120 on a human meter and 68- about 150 on a pet meter......also, ALL meters are allowed to have a 20% variance from the numbers you'd get using professional lab equipment.

It will really help us to help you if you'll fill in your Signature with some basic information like:

Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health problems? and maybe a general area where you live.

To fill in your signature, go to the top right and find your sign on name. Click there and there's a drop down menu....choose "Signature" and a new box will pop up for you to enter the information into. Click "save" and you're done.

Next you'll want to start keeping track of the test results on our spreadsheet. Here are the Instructions on setting up the FDMB spreadsheet. Before we give much in the way of advice on dose, we really will want to see the spreadsheet.

If you have any problems getting it started, feel free to send me a private message and I can set it up for you. Just click on my name and choose "Start Conversation".