Magic's Post Hypo Day 3 Update

[vampfaye]

Thought I'd post where we are with Magic as of this afternoon and what I've discovered as well.

My vet called this morning since I didn't call her yesterday. It was her day off and there was really nothing to report since he is still testing under that 200 mark! She thinks that we are going to be OTJ from this point forward! She said that they can go into re-missive states although it's not often that it happens. I am so excited over this news that I can barely contain myself.

His behavior is back to normal. He was jumping up and down from various perches and windows all day long. He has even been up and down off the bed and in cuddle mode again. One sure sign that he's feeling like his old self is that he was fighting and chasing SpEd all over the house this afternoon. It is good to see him back to his normal self.

After reading on here about Lantus and how long it lasts, I can see where I've made several mistakes with administration. This may have a big impact on why he had they hypo & seizures on Sunday. I've been keeping the vial in the door (mistake #1), prefilling syringes for up to 5 days at a time (mistake #2) and used the bottle until it was empty - close to 4 months (mistake #3). I think that the combination of the vaccination he had and the first few doses from the new vial of Lantus is what pushed him over the edge, especially since it does degrade (see mistakes #1 & #2). I have moved the vial into the same interior drawer of the fridge where I keep my Enbrel injections (I have Rheumatoid Arthritis and take a shot a week), in hopes that it will not degrade like it certainly did by being in the door.

An old high school classmate tried to get me involved here when he was first diagnosed but I was just so overwhelmed that I didn't really do more than lurk once in a while. I'm kicking myself for that now since I've learned so much in such a short amount of time.

Thank you to each and every one of you for your help and concern. Neither of us would be coping well if it wasn't for all of you. I can never thank you enough!

 

[Helene & Cleo]

Hey that's good news that Magic is recovering well from his hypo.

Just had a quick look at your previous posts. Am I right in understanding you're going to continue without insulin, and try and lower Magic's numbers with diet changes etc?

I'm in a similar situation to you I guess, my Cleo is hitting blood glucose numbers in the 115 to 155 range (in US numbers), which is too low for me to comfortably dose her with insulin at the moment, but also just that bit too high for comfort. We had two weeks without insulin with numbers falling within the under 140 range just over a week ago, so I guess that could qualify for the requisite 14 day "OTJ" accomplishment, but I've been reluctant to declare Cleo as being off the juice as her numbers have since crept up that little bit.

I'm now experimenting with diet, just doing whatever I can to try and get these numbers down without insulin. I'm in the UK, and it's kinda tricky to get hold of any insulin other than caninsulin around here; the local vets seem to be determined to only prescribe other insulins in very rare and particular (and expensive!) circumstances. So we really are trying to do what we can without insulin and the associated risk of a hypo!

I'll be interested to read how you get on with lowering Magic's BG, good luck to you!

H

 

[vampfaye]

Yep, the vet said no insulin unless he hits at least 200 then it will be her discretion as to how much. She was shocked that he was on 4 units 2x a day when I took him for his routine visit on Sat (one of her colleagues was treating him at another location prior to Saturday). I moved here about a year ago and left my vet of over 20 years behind and went to the colleague based on a friend's recommendation. I ended up at her clinic since his is a walk in only and had a 2 hour wait Friday. So, I drove the extra 20 mins to her clinic for an appt Sat am and absolutely think that she was meant to be part of the solution.

We are going to try diet and close monitoring to see if we can keep OTJ!

 

[vampfaye]

He ate about 2 hours ago and has pulled a 200. I will check him in about another 2 hours and see if he has spiked over that. If so, if it's still close to 200 I don't think I will give him any insulin. If it's over 250 I will give him 1 unit. Hopefully, he won't need it.

 

[vampfaye]

175 at 4.5 hours after eating!! flip_cat

 

[Helene & Cleo]

He ate about 2 hours ago and has pulled a 200. I will check him in about another 2 hours and see if he has spiked over that. If so, if it's still close to 200 I don't think I will give him any insulin. If it's over 250 I will give him 1 unit.

I hadn't looked at your spreadsheet when I posted last night. Those numbers are creeping up a bit, aren't they?

250 seems to me to be a bit too high to wait to restart giving insulin shots. This is above the renal threshold, the point at which glucose spills into the urine and damage starts occurring to the internal organs, the kidneys bearing the brunt of it to start with.

Has your vet advised you not to give insulin below 250? I really think this is a bad idea as a long term plan. Unless Magic's numbers start dropping in the next couple of days through the diet change etc, if I were you I would post and ask the advice of some of the more experienced members of this forum, regarding what dosage of insulin to start Magic back up on. It's a fine balance between the risk of hypos and the damage done by hyperglycaemia. We are taught to avoid hypos at the expense of slight hyperglycaemia. But when numbers start regularly spilling above the renal threshold (which can be as low as 200-220 for some kitties) you must start considering the potential damage to the kidneys also.

Are you testing for ketones?

If you haven't already, please purchase some ketodiastix from your local pharmacy. These are urine test strips, which will inform you whether glucose and ketones are present in Magic's urine. If ketones are showing up, that's cause for concern.

I don't mean to worry you, or make you lose confidence. I was just a bit worried by your mentioned of a high reading, then a plan not to use insulin unless Magic goes above 250. In my opinion, this is too high to leave it. BUT I am no expert in these matters, especially with regards to lantus dosing; so please do seek the advice of others with more experience than me in relation to dosage before recommencing insulin, if that is what you chose to do.

Best of luck to you and Magic.

H 

 

[vampfaye]

He ate about 2 hours ago and has pulled a 200. I will check him in about another 2 hours and see if he has spiked over that. If so, if it's still close to 200 I don't think I will give him any insulin. If it's over 250 I will give him 1 unit.

H 

The 250 level was just for overnight the night before last. I was going to play cautious until I could talk to the vet this morning. He peaked at 200. I just really didn't want to call her and wake her up (or get one of the collegues). I have talked to her this morning and she wants me to give him 2u if he tests over 200. Standing orders...

 

[terri1962]

Are you able to post over on the Lantus board at all? they have the most knowledge about this insulin, more than most vets. They have been using it for years in their own cats. My own cat BG never ran very high either, 200 or 220. I would give her .5 units twice a day at that number, but don`t go by me.
You also need to give the Lantus twice a day for it to be effective, not once a day. 2 units once a day at that number might hypo the cat again. Like I said please if possible try to post on the Lantus board. They know this insulin the best.

Terri

 

[Julia & Bandit (GA)]

We say a cat is OTJ or in remission when it tests consistently in a normal range (50-120) for 2 weeks straight. Now, some cats may run a *little* higher than that once in a while (when Bandit went OTJ he was still a tad overweight and he was ranging 80-160), but numbers consistently over 180 (the low end of the renal threshold) are an indication that he will still need a bit of insulin. Cats take to remission better when they are weened off insulin in microdoses, rather than stopping it suddenly--that means going from .5u, to .25u, to .1u and then doing a remission trial if everything is mostly in the normal range.

 

[Helene & Cleo]

The 250 level was just for overnight the night before last. I was going to play cautious until I could talk to the vet this morning. He peaked at 200. I just really didn't want to call her and wake her up (or get one of the collegues). I have talked to her this morning and she wants me to give him 2u if he tests over 200. Standing orders...

I'm going to echo the sentiments of Terri and Julia's above posts, and really try and encourage you to post in the lantus forum. Those people really know what they're talking about, the combined experience they have with this insulin is invaluable.

The advice your vet has given you so far, to start insulin, have Magic on 4 units BID, stop suddenly, and now to start again just as suddenly at 2 units BID when he is only just hitting over 200 really concerns me. A lot.

Lantus, like other insulins, works best with small, gradual, incremental adjustments. Slowly increasing, and slowly decreasing. Consistency in regime is important. Also, the adjustments (when already on insulin) need to be made by taking into consideration nadir readings, not just pre-shots. It doesn't seem like your vet is taking this into account sufficiently.

Magic hasn't had any insulin at all for five days now. It seems like he is not quite down into the levels of diet controlled remission just yet - but it really looks like you're nearly there. A little helping hand from some carefully dosed, gently adjusted insulin could be all it takes to prompt Magic's little pancreas into chugging along nicely. But to suddenly jump to 2 units BID after five days without anything could either a) cause him to hypo again, or b) have a rebound effect and cause his BG levels to go too high, making them much more out of control than they are now.

In effect, you're starting insulin again from scratch now. If you think about it in that respect, it doesn't seem quite right to jump straight in at 2 units BID. A gentle push in the right direction with some insulin, starting low, slowly adjusting in small increments, could be all little Magic needs.

I'm not a lantus expert, I've never even used the stuff. But I've read a whole lot about it on this site, a huge amount (mainly because I'm planning on trying to switch over to lantus should my Cleo need insulin again), and from everything I have read alarm bells are ringing at your vet's advice. The forum members who frequent the lantus forums really do know their stuff; I've been amazed by the wealth of experience across this site, but that forum in particular will be very helpful to you right now.

You and Magic are so nearly there, you've both done really bloody well!

Post over in the lantus forum, please. Put a link in your first post to this thread and your original one, and see what the people over there think. But please do it now, before it gets to the point when you're stressing out about a high reading, and unsure about what to do. Arm yourself with the information beforehand, and then you will be best placed to act accordingly when the situation arises.

Love & behind the eat scritches to Magic,

H