Insulin Overdose? Video available

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Maggie_Love

Maggie_Love

Member Since 2016
Hi all. New to Feline Diabetes Forum. Thanks for welcoming me.

I have uploaded a video of my cat, Maggie, having what my husband and I think to be an insulin overdose. I will copy paste description from video below:


"My 8 year old cat, Maggie, was recently diagnosed with feline diabetes. Since the unfortunate news, my husband and I have been instructed to provide Maggie with two insulin shots a day, 9AM and 9PM, as well as simultaneously feeding her a prescribed high calorie & high protein canned cat food. For the past three months this routine has done Maggie a lot of good. She has gained weight, her energy levels have increased, and her personality has really shined. We haven't had any complications until the night this video occurred.

Yes, we immediately made a vet appointment for the next day and Maggie was said to be perfectly healthy. This baffled us.

My husband and I have relentlessly searched high and low for any other internet sources that are similar to this incident as to figure out what exactly happened to Maggie. Also we thought maybe someone else might be out there in our shoes and is just as confused as we are.

Maggie has another vet appointment tomorrow for a fructosamine blood test. Until then we are hoping someone else out there might have an answer to what Maggie had to experience in this video.

Prior to this Maggie was dead asleep on our bed. She suddenly woke up and began moving her head back and forth. I put her onto the floor and she stumbled over. I woke up my husband and I began to record. She walked back and forth as seen in the beginning until eventually sitting down facing me. Her eyes trailed a nonexistent object in the distance until she suddenly fell solemn. I tried to push her bed towards her as she normally climbs in. No luck.

After the video is turned off we fed her food and she gobbled it up. Sooner after she perked back up and was back to normal. She was still a bit twitchy, but it soon subsided. This occurred 5-6 hours after her 9PM dose.

I hope someone can give us some insight.

-Maggie's parents"

Since this video she has had two vet visits. We are currently waiting on fructosamine test results. We have lowered her insulin from 1 unit to 1/2 unit and she has dramatically improved. She's acting like her old self again.

Thanks, everyone.
 
This definitely looks like a hypo episode. which can be very serious or deadly if not dealt with properly. If you are not home testing you really need to start right away. The dose she is getting could be too high and could easily put her into another hypo. A Hypos are serious and require careful and immediate intervention and sometimes an emergency visit.

Please if you are not testing at home, start now!
 
The fact that feeding her helped with the episode lends more creedence that it was a hypo episode. You need to have some high carb food and some sort of sugary syrup on hand. It is good that you have dropped the dose, but cats can be more sensitive to insulin after a hypo. She recovered from the episode, but you don't know how she might react to another one. She would have appeared normal at the vets the next day but. The fructosamine test only gives an average of the blood glucose over a 2 week period but does not tell what is happening at any given time. At the risk of sounding redundant please home test!
 
Hi @Maggie_Love ,

Yes, as Tuxedo Mom said, that does look like hypo symptoms. (Hypos can have different symptoms (see 'Hypo' article that Tuxedo Mom linked to above). But that disorientation and wobbliness is not at all uncommon.)
What insulin is Maggie on?

Cats' insulin requirements can change. And some cats will go into remission (ie. recover to the point where their diabetes can be diet-controlled, either temporarily or permanently.)

The best way to know what is going on with Maggie's blood glucose (and to keep her safe from hypo) is to learn to test her blood at home.
'Hometesting' is a quick and simple process. Most of us use ordinary glucose meters made for humans (although a pet-specific meter, 'Alphatrak' is also available).
In a nutshell, hometesting involves pricking the outer edge of the cat's ear to get a tiny droplet of blood; transferring that droplet to a test strip in a glucose meter; waiting for the meter to count down and give the result; and rewarding the cat with a treat or a cuddle. This should not hurt the cat, and many come to look forward to being tested because of the treats/cuddle. :)

We can help you learn to hometest, if you'd like to. :cat:

Welcome to FDMB! :bighug:

Eliz
 
Welcome to FDMB! You have come to the right place for support. There are a lot of caring and experience folks here. You will be given a whole lot of information and at first, it will seem very overwhelming however in a couple of weeks, things will start falling into place. Below is general information and it will also help you start your shopping lists. Congratulations for finding this place and for seeking more information on feline diabetes.

Good Reading: This is a must read. It is an excellent 18 page informative document that covers feline health and nutrition. Don't take short cuts and read it all. www.catinfo.org Also read other postings and their spreadsheets. You will learn a lot more from others.

Home Testing: Here, we all home test and congratulations to you for wanting to home test too. It is mandatory to understand how your kitty is reacting to the insulin and the dose. You will want to test before each shot and some additional test in between the 12 hour cycle when you can. The main reason to home test is to keep your kitty safe and to find an effective dose. Find a place in your home where you will always perform the test and give lots of hugs and treats before and after testing. There are many videos showing you how to test. Hometesting Links and TipsHere is a picture of where you test on your kitty. http://s106.photobucket.com/user/chupie_2006/media/testingear/sweetspot.jpg.html

Here is another good link on Home Testing:http://www.felinediabetes.com/bg-home-test.htm

Meters: There are many different meters. There is a pet meter called the Alpha Trak2 and human meters. Some use the pet meter because it is what the vets use so the numbers will match up. The meter and strips are expensive though. Most folks buy AT strips from ADW. Most use human meters that can be purchased at any pharmacy. It typically reads a little lower than the pet meter but we have ways of compensating for those lower numbers. Many use Walmart's brand, Relion Micro, Relion Prime or Relion Confirm. The Micro and Confirm only needs a tiny drop of blood but the strips are a little more expensive than the Prime which needs a little bigger drop of blood. They cost around $15 and the strips are around 35 cents each. The AT strips are usually around $1 each at the vet’s office.

Lancets: Lancets are used to poke the ear to get blood for the meters. There are many different sizes lancets (gauges). It is recommended when you are first starting out to use a 26-28 gauge because it is a larger size and will make a bigger hole, hence easier to draw blood. Also, it would be a good idea to pick up Neosporin WITH pain reliever to apply on the edge of the ears and don't forget to alternate ears. It is a bit scary at first to start poking the ear, but eventually it will become easier for both you and your kitty. Some people even draw blood from the paw pad.

Spreadsheets: Our spreadsheet instructions are here. If you look at the signatures of the members here, you will see a link to their kitty’s spreadsheets. We keep track of all our tests. This is basically a place to collect data and help you to determine patterns, doses, etc. It also aids those that may be helping you to better understand your kitty. To further my knowledge on diabetes, I would make it a habit to read other kitty’s postings and spreadsheets. Even though they are all different and will be different than your kitty, it was still invaluable information.

Food: There are many reasons why we are here but one is due to feeding dry cat food which is high in carbs. You will want to consider changing your food to wet, low carb food. It is recommended to feed food that is under 10% carbs and I found with Merlin that right around 4-5% worked for him. Here is a list of cat food to choose from food chartyou will note that the food with fish are lower in carbs however it is recommended that you only give fish once a week due to its mercury content. Many use Fancy Feast, 9 Lives, Friskies, Wellness, Werurva etc. This list can also be found in www.catinfo.org If you are already giving insulin and you have not transitioned to wet, low carb cat food, be sure to test while you are transitioning. This is because by changing to low carb food, it could decrease your kitty’s number by 100 points or more. One last thing, many of us add water to the wet food so your kitty is getting plenty of water to flush out the toxins and to keep them hydrated.

Hypo Kit: Always good to be prepared for possible hypo events (low blood sugar) which means that your cat has reached dangerously low numbers. It can be fatal, hence, the importance of home testing and collecting data in a spreadsheet. In each of the Insulin forums are stickie’s labeled Hypo Links. Here is one: How to Handle a Hypo. Please print and post on your refrigerator so everyone in your household is aware of hypo symptoms. You will want to create your hypo kit that would include and not limited to; extra testing strips, honey/karo/maple syrup, high carb food, medium carb food, vet information, etc. Hopefully you will never need it but probably at some point in time, you will need to deter from going too low.

Ketones: Diabetic cats are susceptible to diabetic ketoacidosis (DKA). It is best to buy testing strips that will measure (if any) ketones in the urine. One brand is Ketostix which can be found at Walmart or any pharmacy. You will want to test periodically unless you continue to get high numbers, then it is suggested to test more frequently. Ketostix typically costs around $10 for 100.

Treats: It is always nice to have treats available for your kitty especially when testing or when they decide not to eat. I like using Pure Bites. I have found it at Petsmart and other pet stores. It is freeze dried and the only ingredient is the meat i.e. chicken, duck, etc. If your cat likes it, then I would go to the dog section where it is cheaper than the cat package. It is bigger chunks but no problem in breaking it up. Another option is to use Bonita Flakes where you can find at your local Asian market. There is a link here somewhere in this site that has a list of low carb treats.

Injections: Most folks here use one of these main insulins; Lantus, Levemir and Prozinc. Two hours prior to your insulin shot, you will not want your kitty to eat. Then you will test and then feed. It is best for your kitty to eat a little before your shoot. I shoot while he is eating. The reason why you do not want your kitty to eat two hours prior to your test is because food elevates BG numbers. So you do not want to dose based on a food influenced number. Here is a link on how to give injections.http://www.felinediabetes.com/injections.htm
 
*** WARNING: LONG POST FOLLOWS ***

Hello Maggie's Parents and little Maggie.

Welcome to you all. I'm very glad you found us. I agree with Eliz and Mary Ann that Maggie's clinical signs during her 'odd' turn, the way she "gobbled up" her food, and her subsequent recovery are strong pointers towards her having experienced an episode of hypoglycaemia. You did the right thing to feed her, and your instinct to reduce her insulin dose was very sound and wise.

I see Mary Ann (@Tuxedo Mom) has given you a link to the FDMB guide on how to recognise and treat hypoglycaemia. If you print out a copy of that and read it through several times it will help you both to be more prepared should Maggie ever go low like that again (Heaven forfend!). Some people keep a copy of the hypo guide on their fridge so it's easy to find should an emergency arise.

Maggie_Love said:
For the past three months this routine has done Maggie a lot of good. She has gained weight, her energy levels have increased, and her personality has really shined. We haven't had any complications until the night this video occurred.
Click to expand...

These observations really caught my attention.

Has your vet mentioned to you at all that some cats can achieve diabetic remission? A cat in remission is still diabetic but is able to stay in the healthy blood glucose range as long as it is fed a suitable low carbohydrate diet (i.e. it becomes a diet-controlled, non-insulin-dependant diabetic). Some cats achieve remission after changing to a low carb diet; some after the diet change and insulin treatment. The chances of remission are greater in newly-diagnosed diabetics who get prompt treatment, and Maggie certainly falls into this category. (Lucky Maggie! :) ) The reduction in carbohydrate load allows the pancreas to rest. This creates a healing environment which can potentially enable the pancreatic beta cells responsible for insulin secretion to recover some of their function.

OK, that's the science bit. Now to the practicalities.

There is no way of predicting when a healing pancreas may start 'sputtering' and producing more insulin. If a cat is being treated with insulin when this happens you can end up with the situation where the previously safe dose of injected insulin PLUS the cat's own insulin results in too much insulin circulating in the cat's system. This can lower the cat's blood glucose too much. Unlike the pancreatic beta cells, the injected insulin doesn't come with an 'off' switch and a hypoglycaemic episode may result.

From your description of the improvement in Maggie's clinical signs (weight normalising; disappearance of lethargy; sociability, interaction and engagement back to pre-diabetic normal levels) it sounds like she has responded extremely well to her insulin therapy. I am assuming that you don't home monitor her blood glucose levels. As someone who does for her own cat, and as someone who has been an active member of this community for 18 months, based on my experience of treating my own cat and reading of the progress of other cats here the improvements you describe tend in general (though not always) to indicate that a cat is in a very good state of regulation - possibly with numbers in the normal range for a healthy cat for a significant proportion of the day. Of course, there is no way of proving that without daily home monitoring. A fructosamine test will give you an idea of Maggie's average BG over the last week or so, but fructosamine testing is absolutely useless when it comes to determining how low or how high a particular dose of insulin may be taking her on a day-to-day basis (hence the reason why so many of us here home test and track our cats' responses to their insulin.)

This is only conjecture on my part, but I think there is a possibility that Maggie could be heading for remission. If you're not home testing then a vet-run curve may give you some guide as to how she's responding to her insulin over the course of the day. That said, even a vet-run curve may show slightly elevated blood glucose levels due to Maggie feeling stressed at being away from her own territory and therefore does not give a full picture of how low a dose may be taking her; but it is better than the fructosamine result. As previous posters have already advised, if what Maggie experienced was a symptomatic hypoglycaemic episode then she may now be much more sensitive to insulin and therefore extra caution is advised when determining a suitable insulin dose for her.

Maggie_Love said:
We have lowered her insulin from 1 unit to 1/2 unit and she has dramatically improved. She's acting like her old self again.
Click to expand...

This also caught my attention. One of the tricky things about giving insulin treatment is that both too high AND too low a dose of insulin can leave the cat in higher numbers. (If the dose is too high, the cat's body's protective mechanisms will kick in and signal the liver to release more glucose into the bloodstream in order to protect the cat from hypoglycaemia.) Assuming for now that what Maggie experienced was in actual fact a hypo episode, that would automatically confirm her dose of 1.o units (I'm assuming this is twice a day - is this correct?) is too high. That you also describe her as having dramatically better clinical signs as a result of the dose reduction could also be evidence that she is running at lower BG levels on the 0.5 unit dose (again, is this given twice a day?). By inference, therefore, the higher dose may have been bumping her BG levels up higher than they need be due to her body's protective mechanisms kicking in.

If Maggie were my cat, I would be very cautious now. I would contact the vet immediately to consult about the next dose. If it were decided during the consult that insulin should be given, I would watch her clinical signs like a hawk. Assuming you're not testing, I suggest the following:

1. Contact your vet ASAP to advise that you think very likely that Maggie has had a hypoglycaemic episode, that you have reduced the dose, but need advice on whether to consider a further dose reduction for safety until she can be properly assessed.

2. Get Maggie to the vet as soon as possible to get her blood sugar levels checked (NB - may be higher than at home but you need a real-time guide to where she is now ASAP, not a fructosamine test.) Although not a 'full cycle' curve, if the vet could keep her in for several hours to do a mini curve to check her fasting blood glucose level and also her blood glucose levels after eating her regular low carb food it could provide valuable information. Sometimes a cat heading for remission will see a lowering of blood glucose after a meal (a functioning pancreas pulses insulin when food is consumed). If the vet tests 2 hours after her last meal, feeds her and then tests at 1, 2 and 3 hours after she eats it might show a drop in BG level (best done when her insulin is at peak effect when considering where to set a safe dosage). There is no guarantee you will see a postprandial drop in BG level, but if you do it provides some evidence that the pancreas may have recovered some of its function and is 'helping out'.

I strongly recommend you consider learning to home test Maggie's blood glucose at home (the sooner, the better). It's the best way to keep Maggie safe and to give you peace of mind. If you can home test, you can determine within minutes whether Maggie's BG levels may be on the low side and intervene to steer her back to safe numbers quickly and straightforwardly. There are a lot of teaching resources here if you would like to learn how to home test and, of course, we're all here to help with hints and tips if you get stuck. :) Most people here use popular, widely available human glucometers together with a human meter/cat-specific blood glucose reference range to monitor their cats' blood glucose levels. Some of us (myself included) use glucometers calibrated for veterinary use. The veterinary meters read closer to lab equipment and use a similar BG reference range, but the strips are very pricey; human meter test strips are usually far more economical. Both can be used safely and effectively to monitor dose effectiveness and safety.

Just to confirm, I am not a veterinary professional nor have I any veterinary training. You must always consult your vet about Maggie's treatment. That said, if she were my kitty, in addition to consulting with Maggie's vet I would: monitor her very closely for signs she might be returning to low numbers (even at night - some cats run lower at night); measure her current, real-time BG levels and insulin dose requirements; and also actively look for any clinical signs that she could potentially be heading for remission.

That's my two penn'orth; other members views may differ. Be sure to keep us updated about Maggie. She looks like an absolute sweetheart. :cat:


Mogs
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Please consider learning to home test Maggie's blood glucose levels! I can attest to the fact that a cat may become more sensitive to insulin after a hypoglycemic episode, as it happened to my kitty. I wouldn't dream of giving him insulin without a test kit in the house, it's one of our most valuable tools and has saved my cat's life more than once!
 
Thank you all for the warm welcome!!! You have all provided crucial and extremely helpful information so we can move forward with Maggie in a more proactive manner.

I apologize for the delay in my response. It's been a busy work week!

My husband and I plan to buy a home tester, but money has been tight with all of Maggie's recent vet visits. We are hoping to get one early next week and make home testing Maggie a constant activity. Until then we have been monitoring her very closely.

Critter Mom said:
Hi,

Just checking in to see how Maggie is doing today.


Mogs
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Click to expand...

Maggie is doing great! She's eating all of her food when we put it down and her energy levels are awesome. She's currently sprinting all over the apartment chasing little mouse toys. :cat:

You were correct about the amount of insulin she was receiving. 1 unit down to 1/2 unit now. We have been literally playing phone tag with our vet the past week. We still haven't heard back from the fructosamine test. Our vet is slacking. :banghead:

I will keep you guys updated on her progress when we get home testing in motion!

:kiss: Maggie_Love
 
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