Is insulin making her worse?

Status
Not open for further replies.
C

Ching

Member Since 2024
I'm at a complete loss right now. Ching's condition worsened significantly. She was admitted 6 days ago due to high blood sugar and very high blood sugar in her urine. She was deemed to be diabetic by the vet the next day, which made them start with insulin (Catsulin). She would not tolerate the dose and kept having multiple hypoglycemic episodes. On the 4th day the found her kidneys to not be in good shape. Which prompted the Vet to increase IV fluids. On the 5th day, she was hypokalemic. Her potassium went down to 2..

They corrected this with adding Potassium Chloride in the NaCl IV. Currently her potassium has gone back to normal (3.3) but she is very very weak and lethargic. I honestly do not know what caused this as her lab values seem to be improving by the day.. Her BP was 57 when they last checked..I begged the vet to not give her the night dose of insulin as I read it could cause low potassium by drawing potassium out of the blood and into the cells..

I am at a loss as to why her BP has dropped this low and why she is feeling so weak and lethargic. The labs do not show that bad of results for her to display these symptoms.

I brought her home last night even for a few hours with instructions to do subQ. I just wanted to make her feel comfortable somewhat because I know she hates it at the vet.. I then brought her back this morning so they can monitor labs, give the insulin shot, give other meds, syringe feed her and possibly return her IV.

I really need advice... In my heart I know she wants to fight. When she was home she wanted to walk around, drink as much water as she can.. she's very groggy and weak though. I honestly do not know what to do at this point..

For those who are interested in her labs and medications, I've compiled them all in this Google doc file below:


https://docs.google.com/spreadsheet...ouid=115554756201914289821&rtpof=true&sd=true
 
I've never heard of an insulin called Catsulin. There is a Caninsulin, also called Vetsulin in the US. Is that the one you mean? If so, what dose are they giving of the insulin? Can they lower the insulin dose so she's not going as low? Or did the vets mention something about ketones or DKA (diabetic ketoacidosis)? If so, you want to keep the insulin dose as high as safely possible.

By BP, do you mean blood pressure? Or BG - blood glucose? A blood pressure of 57 would be really alarming. What device are they using the test the blood glucose? A pet meter or a human blood glucose meter? 57 is fine on a human meter, but too low on a pet meter.
 
For some reason, they are not running all of the tests for DKA like ketones, magnesium, bicarbonate; her chloride is just a little low; however, with the values you do have, this looks more like CKD to me.

Her phosphorus is really, really high and that will make a cat feel horrible. Are they putting phosphorus binders in her food? Her creatinine is not that high now and has come down but also remember that CKD causes low potassium so it might not just be the effects of insulin up taking potassium into the cells. I’ve looked at alot of diabetic cat labs and the majority have normal potassium unless they have CKD. It’s good they are giving her potassium. They should also always be checking her hematocrit or PCV as they are moving towards anemia. I’m stunned they haven’t checked her urine to see what her USG is, if she has ketones, and if she has protein in her urine or could have a kidney infection.

Her liver enzymes are still just very mildly elevated and coming down. I echo Wendy’s questions about BP because 57 is way too low.

I hope she will start to recover very soon. Poor sweetheart.
 
Hi everyone, I'm going to copy here what I wrote to Carla on Tanyas CKD group in the hopes of getting the opinions of folks who have better diabetes knowledge than I do, as to whether this could be what's going on:


"Was there a fructosame test done to confirm that she's truly diabetic? I'm asking because if it was only based on the blood glucose (221) and glucose in urine (+) that day, those don't guarantee that she's actually diabetic. That level of readings can also occur with other problems that are stressing the body, like pancreatitis (plus or minus a UTI, in this case where there was a lot of WBC in the urine, I would say "plus a UTI"). I had that exact same thing happen to my Seymour in December, he wasn't feeling well one day and I thought he was diabetic because he had glucose in urine (+++ in his case) and elevated blood glucose (I tested both at home), so I brought him to the vet and they did a fructosamine test which determined that the glucose was just a transient elevation due to the stress of a pancreatitis flare-up.


All that to say, if there wasn't a fructosamine test then I'd strongly recommend that you join the diabetes group that was linked to in an earlier post [[note I only later realized she was already posting here]], and ask them for advice (since I am definitely not a diabetes expert (I had a diabetic cat once who passed away almost 5 years ago)) - I can’t "recommend" that you go against your vet's prescription but I will say that in your position, if there was no fructosamine test then I would be discontinuing the insulin and seeing if she starts to feel better. (The subsequent blood test that showed a glucose level in the 300s could have been a rebound hyperglycemia effect due to the blood glucose dropping too low because of the insulin...)


Also, if they did test fructosamine, what was the value (and the range)? (I also had a cat once who was diagnosed diabetic because the fructosamine was high, but then after a week of low-dose insulin, he had really low blood glucose, and was taken off the insulin. Not sure if he just went into remission that quickly or what...)"

Carla, I really hope that Ching is improving, sending my best wishes
 
JoanneC said:
but I will say that in your position, if there was no fructosamine test then I would be discontinuing the insulin and seeing if she starts to feel better.
Click to expand...
If Ching is showing ketones, or even worse in diabetic ketoacidosis (DKA), discontinuing insulin is the absolutely wrong thing to do. Which is why we are asking about certain blood work and urine values.
 
Status
Not open for further replies.
Back
Top