Kitty had a hypo event--now cannot see?

[Jenn & Frank Sinatra]

Hi everyone--about two months ago, I adopted a diabetic cat named Frank Sinatra (formerly Squeak). He was on 8u, BID of Vetsulin when I got him. I transitioned him over to Levemir under the guidance of a vet in mid-January and he had a scary hypo event when he had his first dose of 1unit. After he recovered for a few days we decreased his dose to .5u and eventually increased it back to 1u after three weeks of mid-to-high 300 readings. He's been on 1u of Levemir, BID for about 1 month. Last night, he had his food and his insulin at 1730. We were going away for the weekend, so we dropped him and all of his food and supplies off with his groomer, who is experienced caring for diabetic cats and went on our way. She reports that Frank had a hard night away from home and that he was very vocal and anxious about his new home away from home. At 0530 this morning, she administered 1u of Levemir and gave him his food, which, when she returned to check on him, he had refused to eat. Luckily, the snow that's hitting the northeast caused us to change out travel plans and we returned to get him at 1200. The groomer said they noticed Frank started to look wobbly when he walked around 1045--but we had called her at that point to say that we were coming home, so she put him in the crate to keep a closer eye on him and waited for us to arrive. As soon as I saw him, I knew something was wrong. He was in a large crate and he was bumping into the walls and stepping in his food. I knew he was having a hypoglycemic episode. I administered a few tsps of Karo syrup, wrapped him in a blanket and rushed him immediately to our vet. They took an initial BG and it read 31. They administered more glucose orally and by IV fluids and by the time we left the vet at 1330 his BG had gone up to the mid 60s. They advised that we keep him there for warming (as his temp was low) and to continue to monitor his BG. The vet called about an hour ago to say that Frank's BG fell down to 30 again, which they did not expect to happen and that he required an increased dose of glucose. She also called to say that as Frank has started to feel better and come out of his hypoglycemic "fog" that he appears to have lost his vision. I checked with the groomer and she reports observing no seizure activity while he was in her care. Would this hypo event have caused permanent vision loss?? I feel terrible. We're going to pick him up shortly, but I just wanted to see if anyone here can offer some additional perspective. Last time he had a hypo event, my boyfriend reported that Frank exhibited symptoms of vision loss during the event, but as his BG increased, he was able to see again. I just don't know what to do--if there's anything that I should be doing in addition to monitoring him regularaly for the rest of the weekend. I feel like I failed. Thank goodness we had a change in our plans and ended up coming home early (we were supposed to be gone until Monday...). Any advice diabetic cat moms and dads?

 

[Elizabeth and Bertie]

Would this hypo event have caused permanent vision loss?? I feel terrible. We're going to pick him up shortly, but I just wanted to see if anyone here can offer some additional perspective. Last time he had a hypo event, my boyfriend reported that Frank exhibited symptoms of vision loss during the event, but as his BG increased, he was able to see again. I just don't know what to do--if there's anything that I should be doing in addition to monitoring him regularaly for the rest of the weekend. I feel like I failed.

First off, just want to send you a huge (((hug))). You've had such a scary experience....

Temporary blindness with hypo is not that uncommon. And hopefully your kitty will recover from this. Keeping fingers, paws, and everything else crossed for full recovery.
...Clearly the insulin dose is now way too high. And hypo can make kitties even more sensitive to insulin, so dosage should be considered really carefully if he continues to need insulin shots.

I feel like I failed

No, you didn't. You did the very best you could do in the circumstances. Please be kind to yourself.

And please do keep us updated. (((more hugs)))

Eliz

 

[Idjit's mom]

Jennifer, I am sorry I don't have any input on the vision loss, but I wanted you to know we care very much. I just read Elizabeth's post, and also hope the vision loss is temporary. Perhaps when this crisis is over, you could check in with the Levemir forum and get some additional input from the more experienced users. We can help you with getting the signature information done, and a spreadsheet set up so that they will have access to the insulin and BG data.
Best of luck and best wishes

 

[Bron and Sheba (GA)]

This whole event must be very scary for you but you acted very quickly and absolutely did the right things. I’m so glad your travel was cancelled.
I would not give any more insulin until you are sure that the blood sugar levels are stable and higher and he actually still needs insulin. He may not. As Elizabeth said some kitties after an event like this are super sensitive to insulin. IF he does need insulin again I would give a much smaller dose and monitor closely.
I hope the blindness is temporary and he recovers quickly. Please keep us posted.

 

[Jenn & Frank Sinatra]

Update!: thank you all for the quick replies. I picked Frank up from the vet at 1700. HE CAN SEE AGAIN!! He had been given more glucose via fluids and they fed him a jar of chicken baby food. He rode home out of his carrier on my lap and while quiet, seemed much improved from this afternoon. At 1700, his BG as measured by the vet was 70. When we got home, I fed him half a can of wet food and some dry Taste of the Wild. He ate all of it. I let him relax for an hour and just took his BG with my Arkray Glucocard meter and it was 45. Gave him some wet shredded chicken...should I administer
Karo again? Or are these numbers low because I’m using a human meter vs what they’re measuring with at the vet?

THANK YOU ALL for your concern. It warms my heart to have such wonderful support throughout this scary experience.

First off, just want to send you a huge (((hug))). You've had such a scary experience....

Temporary blindness with hypo is not that uncommon. And hopefully your kitty will recover from this. Keeping fingers, paws, and everything else crossed for full recovery.
...Clearly the insulin dose is now way too high. And hypo can make kitties even more sensitive to insulin, so dosage should be considered really carefully if he continues to need insulin shots.

Thank you so much for the reply. I am new to this sugar kitty stuff and I didn’t realize that a hypo event could make him more sensitive to his insulin. I made sure to bring this up when we picked him up at the vet, who then concurred that we should return to .5units BID once he’s recovered.

Perhaps when this crisis is over, you could check in with the Levemir forum and get some additional input from the more experienced users. We can help you with getting the signature information done, and a spreadsheet set up so that they will have access to the insulin and BG data.
Best of luck and best wishes

Yes! I almost posted this initially in the Levemir forum but I was panicked and hoped that in general it would get a few looks and replies more quickly. I have been tracking his BG—I will work to input all that data into the spreadsheet and get that signature set up soon!! Thank you for the well wishes and the suggestions!

I would not give any more insulin until you are sure that the blood sugar levels are stable and higher and he actually still needs insulin. He may not. As Elizabeth said some kitties after an event like this are super sensitive to insulin. IF he does need insulin again I would give a much smaller dose and monitor closely.

Oh my gosh..wouldn’t that be something if he didn’t need insulin? I will be sure to monitor him closely for the next few weeks and give him a half unit instead of a whole if it’s needed... thank you!!!

 

[Squeaky and KT (GA)]

Jennifer, would you edit your title and remove the GA prefix? That stands for 'Guardian Angel' or 'Gone Ahead' indicating your cat has passed which is certainly not the cast!! Up there by the title you'll see 'thread tools' - click that, it will allow you to select 'blank' instead.

Glad he's coming home!

 

[Lisa and Witn (GA)]

If you have not already started, I do recommend that you start to home test. This is one of the best ways to prevent hypoglycemia. For newbies we recommend using a higher "don't shoot" number around 200. What this means is that you do not give the dose of insulin if the glucose reading is under 200. Once you learn how your cat responds to the dose, you may be able to lower that number.

Most people on this site use a human glucose meter to test our cats. The biggest advantage of using a human meter over at the pet meter is that the strips are readily available at almost any pharmacy and they're also less expensive than the ones used for pet meters. If your vet is not willing to teach you how home test, there are some excellent videos on this site that will be able to help you learn to do it. Also do not be surprised if your vet tries to discourage you from learning to test. Just remember you are the one who is responsible for your baby's care and you make the decision as to whether or not you will test before every shot. Also with testing before every shot you will learn how well the dose is working and whether or not it needs to be adjusted.

This is a great forum to be a member of. You have a lot of users that have years of experience caring for diabetic kitties. You can ask us any question you want and we will be glad to help you. Caring for a diabetic cat can be overwhelming initially. But once you find a routine that works best for you, the fear and the worrying almost disappear. We are here to help you along this journey. You'll also find that the bond between you and your cat will only strengthen.

 

[Jenn & Frank Sinatra]

Jennifer, would you edit your title and remove the GA prefix? That stands for 'Guardian Angel' or 'Gone Ahead' indicating your cat has passed which is certainly not the cast!! Up there by the title you'll see 'thread tools' - click that, it will allow you to select 'blank' instead.

Glad he's coming home!

Sorry! I was trying to remove the “911” prefix as the emergent nature of the question has passed. I’m on an iPhone so the navigation isn’t perfect. Thank you!

 

[Jenn & Frank Sinatra]

If you have not already started, I do recommend that you start to home test. This is one of the best ways to prevent hypoglycemia.... Also do not be surprised if your vet tries to discourage you from learning to test. Just remember you are the one who is responsible for your baby's care and you make the decision as to whether or not you will test before every shot. Also with testing before every shot you will learn how well the dose is working and whether or not it needs to be adjusted.

Thanks for the advice! I do currently home test before each shot and I've done two curves so far. I am so thankful that my vet is really supportive and encourages me to keep doing what I'm doing in terms of home testing and learning about feline diabetes. I even shared this website with her; she's impressed with the community at large and the willingness to share all of this information.

 

[jayla-n-Drevon]

 

[Jenn & Frank Sinatra]

Update 2: BG was up to 164 at 2100. He has been snoring on his pillow, which is above mine, on the bed. What a long day!

 

[jayla-n-Drevon]

awe I love a good snore!

 

[Bron and Sheba (GA)]

Update 2: BG was up to 164 at 2100. He has been snoring on his pillow, which is above mine, on the bed. What a long day!

So glad you are both home and he seems happy.

 

[JL and Chip]

Cats can be super sensitive to insulin after a hypo event so be very, very careful if/when you start up insulin injections again.

You will definitely want to get mid-cycle tests in to see how low he's going on a dose.

Be sure to read the Stickies at the top of the Lantus/Levemir forum of you haven't already. They're full of valuable info.

Just as a precaution, I'd double check the insulin syringes you're using to ensure there isn't some other unexpected variable at play as well. Vetsulin uses u-40 syringes but Lev uses u-100 insulin syringes. I assume that you got new syringes when the insulin changed but mistakes can and do happen so it's always worth double checking. It's also worth double checking that the line you believe to be 1 unit on the syringe is actually one unit. It never hurts to post a photo of your syringes here (or the wording on the barrel) to verify.

I'm glad to hear Frank Sinatra is doing better.

 

[Jenn & Frank Sinatra]

Update 3: Frank was sky high this morning at 0600 with a BG of 445. After feeing him, I decided to give him .5u of insulin. At 1000 he was at 404. I took him to the vet to have his catheter removed and Had my first experience with a vet who was not keen on me testing at home or doing any research on diabetes. She basically made it seem like because I didn’t have a veterinary degree I had no business changing his insulin doses or opting for a diet that was not prescribed by their office. She even admitted that she had no experience using Levemir with cats, yet went on to tell me that I should return Frank to 1u and then increase him to 2u based on his numbers today. Discouraging, to say the least. I’m thankful the vet I saw today is not Frank’s normal doctor.

 

[Idjit's mom]

Jennifer, I followed the thread yesterday with my heart in my throat hoping for the best outcome. You had a harrowing day!
And, I'm sure you are still feeling the effects. But it would be very helpful if you could find some time to set up your signature and the spreadsheet so that we can see Frank's info with your posts. It's a whole lot easier than paging back through posts trying to determine what insulin, what dose and the BG levels.
Setting up your signature (light grey text under a post). Here's how:
click on your name in the upper right corner of this page
click on "signature" in the menu that drops down
type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using and dosage amount /glucose meter you're using/what (s)he eats/any other meds or health issues (s)he has. You can add your name, and a geographic location (sometimes the time zone matters)
Regarding the spreadsheet, then we can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
I look forward to following Frank's progress back to better health. You are in the right place for good solid information and a community of caring people.