Lewis - New Diabetic

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gls2

Member Since 2010
So a little history...

We recently took our kitty Lewis (11 y/o male maine coon) to a new vet for an itchy patch. He had been drinking lots of water for a couple weeks prior. The new vet gave him a steroid (despite knowledge of a 2-3 heart murmur). The steroid sent our kitty to the emergency room... congestive heart failure (pulmonary edema). Also while he was there they diagnosed him with Diabetes. He endured 3 days of very careful medicine (the two treatments go against each other!) On day 2, he started having minor amounts of ketones in his blood & urine. During his stay his glucose levels jumped between 300 to 500+, but they couldn't fully treat the diabetes because iv fluids would flood his pulmonary edema. On day 3, he was released.. The amazing cardiologist & staff were able to walk a fine line, treat his heart failure and keep him from going towards full blown ketoacidosis.

So now we have a newly diabetic kitty, and he still has traces of ketones in his urine. He is on a low carb diet (kitten food), and we were giving him 1 unit of Lantus twice daily. About four days ago he started throwing up about 8 hours after each lantus injection.. (may or may not be related to the injection itself). Needless to say, we got tired of seeing Lewis throwing up, so we decided to switch from urine strips (daily) to a blood glucometer reading to see if he could be going hypoglycemic.

He isn't showing any other signs of hypoglycemia (except one time he was hiding under the bed). The vomiting could be related to the diet switch or large amounts of medicine for his heart problems. However, he did go for one entire week at home on the new diet & medicine without problems.

So today we tested his glucose using a generic brand glucosemeter. At about 12 hours since his last injection & before eating, his glucose was at 62 mg. We fed him and he ate 70g (his normal half can) since returning home 2 weeks ago. An hour later his glucose dropped to 59mg. Instead of administering the Lantus, we decided to wait another hour and test again. Now he is at 52mg. We called the vet and they recommended either bringing him in to the ER again (he still has no symptoms), or continuing the Lantus and taking him in to the vet tomorrow.

We opted to do the Lantus shot (and will monitor him through the night) since he has no hypoglycemia symptoms and is as responsive as ever. My guess is that the generic glucosemeter is just giving us really low readings.. I plan to have the vet run his glucose tomorrow, and us do it at the same time, so we can "calibrate" our CVS one.

This vomiting has made me start to think his diabetes may have been steroid induced and that he may be getting better... but I could just be wishful thinking..

Any thoughts? It's a pretty complex case and we don't have any historical data. We do have Caro syrup ready in case he starts to crash.. but since we've been giving him this dosage for 2 weeks now, and the worst we've seen is vomiting.. I'm not too concerned.. I'd be more concerned that his ketones spike because we skipped a shot.
 
i'm too new to help, but this will bump your post to the top of the forum so others can see it..

celi & binks
 
Hello!!
Welcome to Lantus land and FDMB.

Have you set up a spreadsheet to keep track of Lewis' BGs? Directions HERE.

This information about what the readings mean might help. The BG range of a non-diabetic cat is 40mg to 120mg/dL.

I am concerned about administering 1.0U to a 52 preshot. How long has it been since you tested? Do you have any high carb food in the house? If you're not sure, we can add a bit of the Karo syrup to a bite of food.

If it has been more than 30 minute since the last test, can you try another BG reading?
 
We decided to test our non diabetic kitty using the same glucometer just as a baseline... The non-diabetic kitty (who is on the same feeding schedule) just had a 55mg reading... So there is a good chance Lewis' readings are accurate.. (which I think is good news).. We were told Lantus is long-acting insulin... Any idea when we should start checking his glucose to see how the Lantus is affecting it?
 
ASAP, since his number was already low when he got his shot.
Cats don't always show symptoms of hypo.

MJ&Donovan
 
Do another test now. Please post the results.

Do you have any canned food that says "with gravy" on the label? Usually that is HC, and we use the gravy by itself to bring low numbers up quickly. You can also add karo syrup to it if he is really low.
 
If you don't have high carb canned food in the house, do you have Karo/corn syrup, honey, maple syrup, etc?

Only those of us with a lot of data and experience with managing their cat's diabetes will shoot that low of a number. Please get a test in within 30 - 60 min.

Do you have a lot of test strips?
 
Retested and now at 44.. again I still don't know if I trust this glucosemeter.. Still no symptoms. Should I be hesitant to give dry food? We do have some dry food (which I believe is high carb).. Also we have Karo syrup for an emergency.
 
How long has it been since his shot?

You really don't want him to go lower. Feed him some higher carb food, preferably wet (dry kibble takes too long to kick in), or give a bit of Karo.
 
Dry food is typically high carb, but slower to absorb into the system. It would better to put a bit of Karo onto Lewis' food and get him to eat that. Lantus is long-acting, which means he's getting a regular dose of insulin into his body for the next 12 hours. You need to control his numbers with food. Don't give him too much food (enough to make him full), you want him to be a little hungry and willing to eat until his numbers are up.
 
If you don't have canned food other than the kitten food that you've been feeding, mix a few drops of Karo into the canned food. It will raise the carb level. You don't want to feed more than about a teaspoon of canned food. You may be feeding and testing for a while so you don't want to fill Lewis up on food at this point.
 
Shot was at 11:15pm EST... Last glucose read (44) at 11:50PM EST.
I'm afraid this has been going on all week before we got the glucometer. (resulting in vomiting)
All our wet food is low carb kitten food...
 
Janice & Johnny said:
Don't give him too much food (enough to make him full), you want him to be willing to eat.
Click to expand...

How we we gauge this? Lewis is a great eater and has always been on a controlled diet because if he could, he would never stop eating.

1/8 cup? 1/4 cup?
 
gls2 said:
Shot was at 11:15pm EST... Last glucose read (44) at 11:50PM EST.
I'm afraid this has been going on all week before we got the glucometer. (resulting in vomiting)
All our wet food is low carb kitten food...
Click to expand...
please rub some karo on lewis's gums and take him to the ER now.
take the bottle of karo with you in the car in case he needs more.
 
Jill is one of the most experienced Lantus users on this Board. She has been up with people many nights when their cat was in low numbers. If she is strongly encouraging you to go to the ER, I'd pack Lewis up and go. You have a drop into marginal BG numbers in less than an hour after your shot. I'm worried, as well. Please get Lewis to the ER. He has a medically complex presentation and hypoglycemia is dangerous.
 
This is really hard for us... The last ER visit cost us our entire emergency savings and put us into debt... Is is possible to treat this at home?

I'm going to try a tbsp Karo syrup mixed w/ 1/8 cup kitten wet food..
 
If you aren't going to take him, you need to watch him very carefully and test OFTEN. Get those numbers up before the insulin really kicks in. Post as soon as you get any numbers, as well as note what/how much/when you fed him.
 
gls2 said:
This is really hard for us... The last ER visit cost us our entire emergency savings and put us into debt... Is is possible to treat this at home?
Click to expand...
personally, i would not take the chance of trying to treat this at home.
i can't believe the advice the vet gave you. it doesn't make sense...
a). take lewis to the ER, or
b). shoot 1u into a 52
it just doesn't make sense.

lewis has already dropped and the shot you just gave hasn't even kicked in yet. i would go to the ER now.
while you're getting ready to go, put a dish of food down for him. if he eats, it may help. then go. the ER is better equipped to handle anything that could happen.
please go.


come back and update after the dust settles. we worry and care...
 
MJ+Donovan said:
If you aren't going to take him, you need to watch him very carefully and test OFTEN. Get those numbers up before the insulin really kicks in. Post as soon as you get any numbers, as well as note what/how much/when you fed him.
Click to expand...
How often is often? I'm still worried my test is reading low since its an offbrand not meant for animals.
 
I am not as experienced as some and maybe shouldn't have chimed in at all...If Jill is recommending that you take Lewis to the ER vet, that's where I'd be headed. I trust her whole-heartedly and know she wouldn't recommend this lightly.

p.s. I think most of us use human meters. I wouldn't second guess the number.
 
At least every 20-30 min please. The sooner a change is seen, the sooner you can react to it. Hopefully the Karo effects will be visible shortly, but it will also wear off quickly, and theoretically the insulin action hasn't peaked yet. There's a long way to go. Some meters are more accurate than others, true, but it's more important now that you just TEST. I'll try to stick around for a bit longer, but my PC keeps crapping out :-|

MJ&Donovan
 
janice is right... if i thought you could handle this at home safely, i'd stay up all night... as long as it took to make sure lewis was ok.
however, we *could* be looking at a prolonged hypo situation here. that means this could last for 14 - 16 hours... and it may be a battle we can't win.
please take lewis to the ER now... before the next shot kicks in... where he can get the care he needs.
 
I'm with Janice in listening to Jill. Jill has stayed up a good portion of the night with me when I had the data and everything I needed for my cat. You don't have this. Please go to the ER now ....she wouldn't ask you if she didn't think it was absolutely necessary. Please let us know what they do and how he responds. We do care.
 
Just retested.. 12:39.. He is now at 49 w/ no food/karo syrup yet... I'm mainly concerned because at the vet a 3 days ago, his glucose was 270... Just because my home test says he was at ~50.. doesn't mean he really isn't at 250. Just called our vet's 24 hour line and will be working with them as needed... He's eating karo/wet food mixed...

Thanks everyone for your help/.
 
For now, trust your meter! Assume it IS that low.
Please get some food and Karo into him ASAP to keep him from going even lower when the insulin reaches its full effect. Post updates often, please. Hopefully some of the left coasters will be up for a while. My connection here is dodgy and it's 1 am. I pray everything works out for Lewis.

And please don't shoot anything in the AM until you figure out what's going on with your kitty!

MJ&Donovan
 
p.s. cats very often test higher at the vet -- stress, etc. It does not mean your home test is inaccurate.
 
p.p.s. please go to your original post - the first one - and add the red "911" icon so others will take note that this is a potential emergency and help you along.
 
Typically, when we test at +3 (three hours from shot), we see the shot taking full effect. I'm worried about the numbers you might be seeing in the next few hours and likely for the next 12 or so. You'll need to be vigilant about bumping the numbers up. The insulin will be working to bring Lewis' numbers down. Please keep in touch with the vet and update here, if you can.
 
Thanks everyone. Vet recommended wet food & 7ml karo mixed. He happily ate it all. Will take him in to the vet in the am. We plan on verifying the accuracy of my meter.

Shutting down the pc to focus on him for the night unless there are any changes with him.
 
gls2 said:
... Just because my home test says he was at ~50.. doesn't mean he really isn't at 250. ... .
Click to expand...

Nowhere near 250
He is within 20% of the tested value
50 can be 40 to 60 <- possibly extremely low and near hypoglycemic attack
100 can be 80 to 120
200 can be 160 to 240
300 can be 240 to 360
 
If I had listened to my vet Maverick would have been in the same situation you were last night. Thank God you had a home tester.
Maverick's blood glucose is much higher at the vets also - they don't show how stressed they are inside but their blood sure shows it.

I really hope you take the advice of the group here. They help thousands of cats with diabetes management. I am fully confident in managing Maverick's diabetes with their help and his numbers show how good he is doing. He was only diagnosed October 17th. Please look at our spreadsheet. he's only on .5 units twice a day now. You will save a lot of money not racing him into the vets and you can do your own curves at home.

You are Lewis' guardian and advocate. Please don't go blindly listening to a vet because they have a white coat. You should read Bid's mom's posts in the past few weeks. Bid is off insulin now.

Wishing you were able to get through the night and anxiously awaiting an update also.
 
Lewis is doing well.. Sorry for not coming back right away. His glucose went to 109 on our meter after giving him the Karo syrup mix. We then worked with our vet to "calibrate" our human meter to their vet meter. Our meter consistently reads 40-50 lower than the Abbot Labs AlphaTRAK. We're considering purchasing that one to be sure, but Lewis hasn't had insulin since that night. He appears to be self-regulating (potentially through the low carb diet). We're going to give it some time, then take him to an IMED specialist.
 
Great news! Amazing what getting them off the dry / high carb food can do.

The vet's Alpha track does read higher than human meters, but it is usually a consistent difference. The Apha's strips are really expensive and hard to get, only through the vet or online. That's why most of us use human meters. I think you said that you got a "house brand" meter from CVS? If it has "true" in the name it might be the exception to the rule, many of us have been dissatisfied with that brand, it doesn't read consistently with other meters as the BG increases. Alot of members use the Relion fir Walmart, or the One Touch Ultra or UltraMini.
 
Thank GOODNESS you caught this when you did! That is SUCH a relief! i for one, was fearing the worst for Lewis, I must admit...

Don't waste your money on the vet model meter it's really not necessary. Any of the decent brands of human meters is perfectly fine for cats. You will see in peoples'sigs and profiles what people here use, there;s quite a variety but apart from the one already mentioned they are all pretty good. Getting one that needs a very small drop of blood, is probably a good idea too...!!!

DO, PLEASE, continue to keep an eye on Lewis with regular tests at least twice a day for the next couple of weeks (I'm sure the wiser heads will chime in on this if needed!!) - you can never know for sure... unless you test...! And who knows maybe you can have an OTJ party here soon!

Testing Lewis yourself at home almopst certainly saved his life. Well DONE!
 
I'm so glad this situation worked out well. I think you probably heard the collective sigh of relief from the people here.

It is certainly possible that Lewis is a steroid induced diabetic. Once the medical issues were better controlled and you put him on a low carb diet, his blood glucose levels seem to have gotten under better control.

As others have noted there is a consistent difference in the readings of the AlphaTrack or laboratory serum chemistry equipment. There's roughly a 40 point difference. Very few people here use an AlphaTrack for the reason that Ann noted. There is a Consumer Reports rating of glucometers that I've linked. The drugstore chain, house brand meters (True Track, True-to-Go) are generally the most poorly rated.

I would echo Perry's suggestion about testing. In fact, I would handle this much as we do an "Off the Juice" (OTJ) trial. For a 2-week period, test twice a day at the same times you were previously giving a shot. If numbers are below 120, no worries. If they are higher, feed a low carb snack and re-test in 3 - 4 hours. If the numbers come back down, what you're seeing is a working pancreas.
 
I am so glad that Lewis is doing well. We were all worried about him. I concur with what the others have said. Home testing most certainly saved his life. Good job!
 
About the meters... you don't need the expensive Alphatrak meter. The price is high and the strips are not conveniently purchased.
The majority of people just use human meters and they are perfectly fine for the purpose.
I like to use Bayer Contour because it DOES give me lower BG numbers, and with my acros, I try to stay above 100, so I prefer the Bayer. My backup meters are OneTouchUltra and I also have a precision xtra.
They all serve the purpose; you don't need to be bang on exact.

As for being 250 at the vet and 52 at home, stress is likely your reason.
One of my cats ALWAYS tests higher at the vet office and the other tests LOW at the vet office. When we get home, they both return to their natural, at-home, relaxed BG numbers. Most people feel stressed when they are at the dr office and so do animals. They are usually at the vet because they are sick and that's stressful too.
 
Lewis has been off insulin since this event occurred and his glucose has stayed consistent the entire time!

Moved my new question to a new thread.
 
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