Just started insulin- please help (Resolved)

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Romeo's Dad

Hello, I am new here and just made a post in the introductory forum. My cat just started insulin three days ago (Humadin-N) after being diagnosed with diabetes. He was basically fine prior to having blood taken from his leg for the test that turned out to show he had diabetes (i.e., just showing some hunger issues and weight loss over the course of a month). After having the blood taken, he started to walk very funny on all four paws and his breath and waste smelled terrible- like bad fruit (but both of these seem to slowly be returning to normal). We are on the third day of his insulin injections (two units every 12 hours), and his quality of life just seems very poor to us. He sleeps constantly, and when he walks his head is crooked under his chin and it is a very sad and disconcerting sight to see. The vet suggested something like this might happen, but I do not know/forget if he said this is normal. Could he be in pain? Will it last long regardless? I have also noticed that he has stopped cleaning himself, and his coat smells like medicine. He also feels very light when I pick him up- almost lifeless. We are going for another blood glucose check in three days, but if he is in pain or I am somehow damaging him with the injections I don't know if I want to even wait that long.

Fyi, his sugar was over 400 after the initial test, and in the 200s post-insulin when checked yesterday mid-day- and so the vet advised things were going in the right direction to regulate him. Am I wrong to be overly concerned about what I am seeing? It is just so sudden and drastic compared to how he was prior to being on insulin.
 
Vet stress can raise BG by 100 points or more. Thus maybe 2 units of N is too high. 400 is not that high for a vet-measured BG.
What are you feeding?
Most of us here test our cat's BG using a human BG meter like the ReliOn Confirm from Walmart.
I would quickly try to get a human meter and measure your cat's( name?) BG. Also, I would reduce the dose to one unit too especially if yu can't measure the BG
 
Romeo's Dad said:
his breath and waste smelled terrible- like bad fruit
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Hello Romeo's Dad, and welcome to FDMB, :bighug:

Did your vet test Romeo for ketones?
I strongly suggest that you get some Ketodiastix (or equivalent) from a pharmacy and test Romeo's pee for ketones. It's not as hard as it sounds. You just need a little pee sample to dip the test strip into. Crumpling some plastic food wrap in the litter tray can help to catch a sample.

Does Romeo's breath smell like peardrops/acetone?

Eliz
 
You are not wrong to be concerned and you shouldn't wait to get Romeo to a vet.

There are a couple of things that could be happening. One is that Romeo's glucose could be going way too low. Larry's suggestion of getting a glucose meter is right on. (Most people here test their cat's blood.) Very low glucose is very dangerous and needs to be treated.

The other possibility is that Romeo has ketones as Eliz mentioned. Your mention of his breath is suspicious. This is also very dangerous and needs to be treated promptly.
 
Hi Romeo's dad,

It can take a little while for a cat's body to get used to 'foreign' insulin but, even so, Romeo's reaction seems extreme. I'm very concerned about the fruity smell on his breath. If he were mine, I would be very, very worried about him and I would be calling my vet right now to get Romeo checked over ASAP - for ketones, and to gauge the effect of the Humulin on blood glucose levels (I'd seriously consider asking the vet to run a curve since you're not yet home testing). I'd also be concerned about the size of the insulin dose. I wouldn't wait to get home testing supplies. If Romeo does have ketones, he really will need veterinary support as soon as possible. Try to get him to drink as much water as possible in the meantime. Maybe add some to his food. (Extra fluids may help flush ketones from the system a bit till you can get the vet to check him over.) I'd also ask my vet about treatment with a gentler, longer-acting insulin such as Lantus (insulin glargine), Levemir, or one of the PZI/Prozinc-type insulins: they suit cats and their fast metabolisms better and also tend to give better overall glucose regulation. (Saoirse's BG control was much better on Lantus, for example, and she felt better in herself on it, too.)

That Romeo has stopped grooming may point to his possibly feeling really lousy. In general, diabetic cats at diagnosis stage may be lethargic, possibly depressed, and their coat condition poor (greasy, dander-ridden). Coat condition may possibly even deteriorate a bit after commencement of insulin therapy. (Saoirse shed like a mad thing not long after she was started on insulin). From my own experience of treating Saoirse with Caninsulin (aka Vetsulin) and also from what I have read here that in-out insulins with hard, fast onsets can make a cat feel absolutely lousy because of the wide swings in BG level during the course of each cycle. Saoirse looked absolutely poleaxed when she first started treatment. :( I don't have any experience of using Humulin-N but from what I've read here I believe that it may indeed drop BG harder and faster than Caninsulin.

Even though Romeo's overall clinical signs may not be great at the moment, there should be a dramatic improvement in his appearance and energy with the right type and dose of insulin. Any time you're worried about Romeo's clinical signs and quality of life always speak to your vet as soon as you can, but please don't think that Romeo will always be this poorly. Saoirse was terribly ill last summer. Now she looks younger and brighter than she has done in years. The early days are very overwhelming, but as you learn more and develop a routine that works for yourself and Romeo things will get better, and all going well so will Romeo. Diabetes is very much a treatable condition.

:bighug:
 
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Thank you all for this feedback. This is quite a roller coaster for the cat as well as us. I called the vet's emergency number since they are not open Sunday. He advised to skip the insulin tonight and in the morning and bring him over first thing for further observation. In the mean time, I am to feed him as usual. We are only three days in with the insulin and everything just seems so extreme. I will use the opportunity tomorrow to ask him about ketones and whether the type/dose of insulin needs to be adjusted. I am at such an early stage that we have not even discussed things like home testing and glucose meters, etc. I don't know anything about these things. Right now Romeo just seems way too sleepy and weak for my comfort, and the fact that he cannot pick his head up is breaking my heart. His pupils are a bit dilated too, although he seems very alert and purrs when being fed and petted. Maybe his sugar has gotten too low, but if so, then I do not know why I didn't see this type of reaction yesterday or Friday.

By the way, the fruity smell on his breath and with his waste happened the day after the vet drew blood for the testing. They were running checks to see if he had cancer, diabetes, hyperactive thyroid, etc. That also caused his strange walk for about two days. I am thinking maybe the loss of blood was causing him other issues due to the diabetes (I know I have a lot more reading to do about the condition let alone the treatment). The fruity smells are pretty much gone at this point, but I will mention them again at the vet tomorrow. Thank you again for your replies. I will re-read them again in detail tomorrow once everything with the cat (and my mind) hopefully stabilizes.
 
You might also want to get the vet his potassium levels as my cat remi actually appeared to get weaker after starting insulin and this was due to a drop in potassium levels that can apparently happen when you start using insulin.

Re the hometesting most vets don't mention it to per owners, it is usually something we take on ourselves after reading about the benefits.

Here is a great link about how you go about doing it.
http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
It really is the best way of keeping your kitty safe from going too low

This link gives you the signs of low blood Glucose to watch out for
http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Ketones are also a very dangerous thing and should be monitored for whenever blood Glucose is too high. As others have said besides the smell there are also urine test strips you can use (and a blood monitor). Ketones are a risk if you aren't giving any insulin and so it is important to try to ward them away by making sure that Romeo has enough water and enough food. You could try adding water to his usual wet food to help keep him hydrated or if he will accept water in an oral syringe you could try giving him some carefully that way (aim from side to side of his mouth and not down the throat).

Finally the insulin itself could make him feel shitty. When remi was on caninsulin it hit too hard and didn't last long enough. When we switched to a long lasting insulin, lantus, it was like night and day.

Have a read of the treatment guideline document before you go to the vet and see if he will consider switching you over

http://www.felinediabetes.com/FDMB/...-from-aaha-convert-your-vet-if-needed.131187/
 
Don't let it get you down, we've all been there! That terrible sad, sad feeling that we're going to lose our beloved kitty and are really doing what's best them or are we being selfish and making them suffer simply because we can't let go. But it really is manageable.

First and foremost, if your vet doesn't do a good enough job explaining things like, home testing, food, ketones and what to expect in the beginning, PLEASE find a new vet asap! It's their job to do this. Our Goof's first test BG test registered 658, it took a while, but on ProZinc he's stays in the low-mid 100's with 2 units.
 
You have received a lot of very good advice from those who have replied to your thread. I also agree that it's very possible Romeo is getting too much insulin, but there's no way to know for sure without testing him yourself. Some of the symptoms you describe sure sound like a hypo episode brought on by too much insulin. Home testing is an excellent way to confirm or disprove that and keep Romeo safe.

I am glad you are taking Romeo back to the vet ASAP. As suggested by your vet, it's a good idea to skip tonight's PM insulin and tomorrow's AM insulin. However, there's a real possibility that his numbers may be quite elevated by the time you get him back to the vet. I can't advise you on how much insulin to give your fur baby, but I think I would base the dose on numbers collected at home, not in the stressful vetty environment. It's usually a good idea to start out with a lower dose and increase slowly, as needed. There are others here who are very qualified to help you with adjusting the dose. Please don't be afraid to ask for help.

Many vets don't encourage home testing, but DON'T let that stop you from going out and purchasing a meter and test strips. They're not expensive and they're easy to use. You don't need to purchase an expensive pet meter from your vet. It's an option, but it isn't a requirement. An inexpensive human meter will work just fine and a prescription isn't required. Most of us here use human meters. I use a ReliOn Micro from Walmart. You also don't need your vet's permission to do home testing. First and foremost, you need to know where Romeo's numbers fall before giving insulin, and you need to know how low a specific dose takes him. The only way to confirm this is and keep him safe is by home testing. Best wishes to you and Romeo. I look forward to hearing about his progress.
 
See my signature link Secondary Monitoring Tools for assessments you can do fairly easily and which will help you and your vet zero in on what might be wrong. Especially check for dehydration with the scruff test and the gum test. Diabetics can become dehydrated very easily when the glucose is high.
 
The last thing you would want to do if your cat has ketones is skip the insulin dose. That could quickly lead to DKA, diabetic ketoacidosis.

Not enough insulin, not enough food, infection and/ or inflammation is the perfect setup for DKA.

Please, go buy some ketone testing strips at the nearest pharmacy/ drugstore and check the urine for ketone levels.
 
Thank you all again for the information you have shared and the well wishes. I find that I need the support just as much as the information these days. My biggest fear was that Romeo's BG had dropped too low and that he was going to stroke out or go into a coma overnight. I also got myself into a state that maybe I had messed up with the needle and caused him some type of paralysis. I hadn't come across anything online about a cat starting insulin and the reaction being that he could not lift his head up in any way- especially when walking. I have had many pets in my lifetime and seen them pass on under various circumstances once the end days came, but never in life have I seen such a sad sight as my cat walking around basically pushing his face forward on the ground unable to lift his head.

So after another night of restless sleep I made my fourth trip to the vet in a week since this all started. He of course had seen the issue before, and as phlika29 mentioned above it turned out to be very low potassium. His sugar had risen to 534 after 24 hours without insulin, but his potassium was also in red-flag territory at something like 2.4. He is spending at least today and tonight at the vet on an iv to get stabilized, and they will handle the insulin until I bring him home. I was advised that once the potassium levels stabilize that they would remain that way and so hopefully this will be the scariest episode to confront for awhile.

We reviewed the urine tests and discussed ketones with the vet, and thankfully Romeo shows no signs of them. I also inquired about adjusting the dosage or switching to one of the longer-lasting insulins, but the vet cautioned against making changes to the type of insulin so soon after starting as they remain in a cat's body for quite some time and his body hadn't adjusted to the first one yet. The dosage could be adjusted up or down in the process of getting his BG stabilized though. I am going to look into purchasing a meter for home-use at some point this week, and will read up more about ketones and the testing meter/kit? as well (although this sounds a little more challenging in general- let alone the fact that I have two cats who share the litter box).
 
You must be very stressed and totally get that you need the emotional support. When remi was diagnosed I could think of nothing else and just cried for days.

I am glad there was a reason for the weakness. At least that can be treated but I have to say that it is my understanding that you need ongoing treatment to keep the levels to where they need to be. I just add a liquid supplement to remi's meals (beef flavour) and it keeps the level where it needs to be. I don't think you can get the same supplement in the US but you can get tablets that you sprinkle into food.

This is a great link but I really think you will need to continue supplementation, hopefully others will comment.

http://www.felinecrf.org/potassium.htm

So it sounds like this may have been the main reason for the overall weakness and lethargy rather than a possible hypo but I still would advise you begin to test blood Glucose once Romeo comes home. Take the time that he is at the vet to read through that link I posted yesterday.

With regards the insulin it doesn't stay in the system long, you could switch over quite quickly but it sounds like your vet wants to give the one you are on more time. By testing at home you will be able to feed back how well or not this insulin is controlling Romeo glucose levels and push for the longer lasting insulin.

Best wishes

Sarah
 
I'm so glad Romeo is going to be ok!

Going forward, learning to home test glucose levels is really the key to treating this disease. As others said, we use a human glucometer. We test before shots to assure us that it's safe to give insulin. We test about halfway between shots to check to see how low the glucose goes. All this data allows us and our vets to better control our cat's diabetes.

Ketones are tested using urine strips bought at a drugstore. If Romeo will allow it, you can just use something to catch his urine as he pees. I know some use a ladle. I used pill cups.
 
@Romeo's Dad , so glad to find your update. Now that you know what's going on with your boy, his treatment can be updated, and you can move forward with his getting better. Trust me, here... you CAN do the testing thing. It sounds intimidating, but it's really not that bad. And it is key to Romeo making progress toward getting back to normal. You will get the hang of it.

Hugs to both of you. :bighug: I certainly know how stressful this has been on you. Tonight, I hope you can get some much-needed sleep.
 
Hi Romeo's Dad,

My heart went out to you when I read your description of how your beloved boy was trying to move. :bighug: I'm very glad to hear that you found the cause of the problem and that Romeo's doing better now. It must have been very scary for you. :(

Reading your update brought back so much of what I went through in the early days after Saoirse's diagnosis. After a bit of a rough patch after initial diagnosis I was lucky to find a very diabetic-friendly veterinary practice (they're lovely) but I also needed a lot of emotional support (I live alone) and I found that here. It made the world of differencegreat deal of but that only addressed part of my needs at the timewent part of the way to the hellpThe vets we moved to 're with now are greatI would have been lost without the emotional support I received here.

While Romeo's in hospital, I recommend that you try to get as much rest as possible because it will sustain you when he returns home. I was out of my mind with worry when Saoirse was first diagnosed. She stayed in hospital for a few nights and the rest I got while she was there made a significant difference in the days that immediately followed.

I echo the suggestions about using this time to get yourself a meter and reading up on how to home test. I had the unfortunate experience of having to give Saoirse insulin 'blind' in the early days after diagnosis as I got no support from the diagnosing vet for my wish to home test. Thankfully our new vets were all for home testing. The difference to one's peace of mind between dosing blind and home testing is like night and day. I'm sure you'll feel much better about things when you're able to check Romeo at home. :)
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I just wanted to post a follow-up as a thank you and courtesy to everyone in this thread who shared their thoughts and support during what was a very difficult time. Romeo had to spend four days in the hospital in order to have his potassium levels replenished and stabilized, but he has been doing much better since. He was so happy to come home and have the strength to get about the house again. The potassium depletion had resulted in a condition that looks like something called hypokalemic polymyopathy (although my vet did not want to call it this). It was very scary and heart-breaking to witness as I thought Romeo was suffering and his body shutting down, but apparently it is a very treatable condition if addressed in its early stages. His insulin dosage was halved as a result of all this (still on Humulin-N), but his blood glucose numbers have been good so far. On my vet's advice, I have also begun incorporating the Diabetes Management "DM" brand of pet food into his meals as at least a short-term precaution to ensure he can maintain his potassium levels, and he has been gaining back some weight as a result. Hopefully we are on a stable course for awhile, though I still have more reading to catch up on. Thank you all again.
 
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