? NEED ADVICE ASAP RE: Hypoglycemia (Please see my 2nd post below about Buddy)

[Kelly and Buddy]

My cat Buddy was diagnosed with diabetes back in April. He was in the 400s and was started on vetsulin 2 units and eventually ended up on 5 units but was still not regulated. At that time I was with a new vet (because we just moved and my old vet is 45 minutes away). I did not care for new vet; she just kept handing me directions and telling me to inject with no curves or glucose checks at home (she never even suggested it; shocking, I know, LOL). I ended up switching back to my old vet who is not a Vetsulin fan but she didn't want to switch insulins until she had attempted to regulate him.

Buddy has other issues. He is a long-time hyperthyroid cat but is regulated (T4 checked in April and again within the past month). He has also had a long history of diarrhea. When put on the diabetic diet (Hills and RC), his stool became unbearable. It was liquid and the smell would clear out my entire house. It was awful. So, my poor vet was trying to balance that and regulation. I won't go into all the things that happened along the way (LOTS of high BG levels) but, after being switched to Lantus and a canned diet, we are at the best place we've been in months. But he still isn't regulated.

Buddy is down to about 8.5 pounds and he used to be about 15. His appetite is off the charts and I think he would eat 10 cans of food if I would let him. Currently, he is eating an entire 13 oz. can of Friskies Turkey and Giblets pate (with reasonably regular stools) split into 4 meals throughout the day. The transition off of kibble has just happened over the past two weeks and you can see on spreadsheet it has made a HUGE difference in his BG. Two weeks ago, he was still on 4 units of insulin and was hitting the high 400s and 500s (while my vet kept him at her house because he was not doing well).

Here are my questions/concerns:

1) . Am I feeding him too much? The can says one 3/4 to 1 ounce per pound so, technically, I should be feeding about 3/4 of the can but he eats all 13 ounces and is still constantly on the prowl for food (stealing dog food, hidden cat food, scavenging my sink, and constantly begging for food).

2) He is down to only 1 unit of Lantus but he gets low enough that I have not been able to give two shots in a day for the past 5 days. To compound this issue, his "low" is definitely atypical and he has even still been dropping 12 hours later. I feel like he might do better on .5 units 2 time a day but I don't think my vet will be keen on that. Maybe she will. If I do that, I will need to get syringes because all I have is the pen currently.

3) I am a teacher and I go back to work on Monday. I am so worry about not having him regulated and having him on the "low" end when I go back. Any suggestions on what I should do? Spreading his meals out evenly will be extremely challenging.

Any suggestions or advice any of you can offer would be greatly appreciated. If it weren't for reading on this page, I would have injected him last week when he was at 40 (before his dose was reduced) because he showed NO symptoms of being so low. Because of this website, I had all the BG testing materials and just happened to test him. Lesson learned. I will never make the mistake of not testing again.

Sorry this is so long. Lots of background to provide for a complicated kitty.

 

[JoyBee&Ravan]

Until you get some advice about the dose i would wait on the shot. Buddy is in low numbers now.Maybe edit your title to ,? Need dose advice ASAP!
It won't hurt him to wait but the shot could send him too low.
Wish I could help !

My Ravan has been diabetic 6 months & is still not regulated. It takes longer for some kitties.

Buddy is doing really good. Not to worry.

I hope someone answers your post tonight.

 

[Kelly and Buddy]

I am worried my boy may become hypoglycemic and I'm really regretting that I gave him his p.m. shot despite being at 173. At +3, he has already dropped to 101. I just fed him his last portion of food for the night and am wondering if I should go ahead and give him some high carb canned food - just in case.

My other question is how soon should I test again? Is 2 hours too long? I hate to prick him so much but I sure don't want him getting below 50. Hopefully someone else out there is a night owl like me.

 

[Chris & China (GA)]

1) . Am I feeding him too much?

No...until he's better regulated, he'll eat more because his body isn't able to process the nutrients correctly.

2) He is down to only 1 unit of Lantus but he gets low enough that I have not been able to give two shots in a day for the past 5 days.

Those of us with enough data will shoot anything over 50 (on a human meter) but we generally say if they're over 150, go ahead and shoot the scheduled amount......then gradually learn to shoot lower Pre-shot numbers as you gather more data and on days you're able to monitor and test more.

Right now, I'd probably keep him on 1U both AM and PM, but if you're really concerned, you could go to .5 with the correct syringes.

All these syringes have half unit markings (very important when you're doing microdosing) and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
B/D

They're also available at WalMart if you have one near you. Their Relion brand 3/10ml, 30 or 31 gauge, 6mm or 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100 (although a lot of them don't realize they DO come with half unit markings!)

3) I am a teacher and I go back to work on Monday. I am so worry about not having him regulated and having him on the "low" end when I go back. Any suggestions on what I should do? Spreading his meals out evenly will be extremely challenging.

You might want to read this "Is TR possible with a full time job"? thread.....lots of good ideas even if you're not doing Tight Regulation

 

[Chris & China (GA)]

should go ahead and give him some high carb canned food - just in case.

No....that's not a terribly bad drop and if you just fed him, that should help stabilize him

My other question is how soon should I test again?

I'd test him again in no more than an hour just to make sure he's still doing OK....Welcome to the world of sleep deprivation!!

 

[Kelly and Buddy]

Thank you for all your responses and suggestions. It seems that he drops for so long that such a large drop just worries me. Hopefully the food I gave will keep him stable but it is his usual low-carb canned. I have some higher carb canned food but I hate to switch food if I don't have to. I have all my "hypo" supplies ready but I'm really hoping they stay on the shelf.

Fingers crossed.


UPDATE: Per your suggestion, I retested just one hour later and he had dropped from 101 to 68 in an hour, despite the fact that he ate 3 oz of food one hour ago. I was afraid I wouldn't get responses this late so, in a panic and based on his previous data/declines, I went ahead and gave him some high carb food and karo syrup. Not sure if that was the right thing to do but I was afraid if I waited he would before I caught it. I dread seeing his numbers tomorrow. Arghhhh....

I'm so frustrated and feel like I just took so many steps back. If I could rewind time, I would never have given him the pm shot.

 

[Chris & China (GA)]

I went ahead and gave him some high carb food and karo syrup. Not sure if that was the right thing to do but I was afraid if I waited he would before I caught it.

That's fine.....the first few times they drop like that, it's scary!!!

68 was still a safe number, but I would have hoped he wouldn't have continued to drop that much

Test him again in 30 minutes and IF he goes up around 80, test again an hour later....if he's still doing OK then, he's probably going to be fine the rest of the night.

When you come back to update, please make a new comment under your older one....when you "edit" the same comment, it doesn't generate a new notification for those of us that might be watching.

 

[Chris & China (GA)]

I'm so frustrated and feel like I just took so many steps back. If I could rewind time, I would never have given him the pm shot.

You actually did what we would have suggested, so don't kick yourself.

The reduction in carbs with the new food is kicking in big time and it's kind of like starting over with data-gathering.

We want them to spend as much time in healing numbers (50-120) as possible so that hopefully the pancreas can heal and go back to work but it sure can be hard on us beans!!

 

[Bellasmom]

Thank you for all your responses and suggestions. It seems that he drops for so long that such a large drop just worries me. Hopefully the food I gave will keep him stable but it is his usual low-carb canned. I have some higher carb canned food but I hate to switch food if I don't have to. I have all my "hypo" supplies ready but I'm really hoping they stay on the shelf.

Fingers crossed.


UPDATE: Per your suggestion, I retested just one hour later and he had dropped from 101 to 68 in an hour, despite the fact that he ate 3 oz of food one hour ago. I was afraid I wouldn't get responses this late so, in a panic and based on his previous data/declines, I went ahead and gave him some high carb food and karo syrup. Not sure if that was the right thing to do but I was afraid if I waited he would before I caught it. I dread seeing his numbers tomorrow. Arghhhh....

I'm so frustrated and feel like I just took so many steps back. If I could rewind time, I would never have given him the pm shot.

We all get scared when we start seeing lower numbers, actually 68 is a awesome number, it will get easier and the panic will go away as you see more lower numbers, as long as you are able to test, you did great on shooting, this does get easier, patient pants is what I’m told a lot lol lol

 

[JanetNJ]

It would be very helpful if you could add some info to your signature. Click on your name at the top right corner and choose signature. Add info such as your pets name, date diagnosed, insulin type, food you're feeding, meter you use, and any other health concerns such as the weight loss, medications, ect.

 

[JoyBee&Ravan]

Good Morning Kelly and Buddy! It looks like you got a lot of Good advice . Just take a deep breath & start reading the yellow Stickies . It's a lot of info to take in but little by little it will get easier. Not EASY but easier!

Buddy is doing so good with with his #'s already. Just stopping the dry food can sometimes bring a cat into remission. It's a good thing he lost weight! I let my Ravan eat when ever he wants, & he's not over weight. He eats mostly a Raw meat diet & some good canned food.Also make sure to have a lot of water out ,they can get very thirsty from diabetes. I use only distilled water & only glass bowls & dishes for him.

Once you understand how the Insulin works it won't be as scary to see the lower #'s. You can click on My kitties SS (spreadsheet) or anyone else's & get an Idea of how other kitties are doing.At what numbers we shoot at.

We're all waiting to hear more info. How's he doing this morning? ( going without sleep is just part of dealing with Diabetes!)

Hope you have a Great Weekend!

 

[Sienne and Gabby (GA)]

Welcome to the group!

By any chance, did you get any additional tests after your +4 of 68? If this were my cat, I would have kept testing. You might want to look over the sticky on "Shooting & Handling Low Numbers."

Lantus works best if dosed twice a day. It's a depot type of insulin (there's a sticky note describing what the depot is and how it works) which means this is a very different approach to dosing than a shorter acting insulin like Vetsulin. When you skip shots, it has an effect not only on the cycle but on the depot, as well. It would make much more sense to reduce the dose so you can shoot twice a day.

You do need to get syringes. With cats, you need to have greater flexibility with dosing and with the pen, you can only shoot in 1.0u increments. We make dose adjustments in 0.25u increments. Getting syringes that are marked in 0.5u increments will allow you to adjust your dose in finer amounts.

By any chance, did your vet(s) test Buddy for exocrine pancreatic insufficiency (EPI)? The vet would have gotten an fTLI (feline trypsin-like immunoreactivity) test. This is a link describing EPI. One of the cardinal symptoms is weight loss and not gaining weight despite eating. Treatment involves adding a pancreatic supplement to your cat's diet.

If you don't already have one, a timed feeder may be very helpful, especially once you are back at work. It gave me considerable peace of mind to know that my kitty had access to food when I was at work.

 

[Kelly and Buddy]

Good Morning,

Thanks for all your responses. It is nice to know I have some people in my corner because everyone else I know thinks I'm crazy for doing all this.

I stayed up another hour and watched him like a hawk. No change in behavior; if he had been lower than 68, I wouldn't have waited an hour to test. At the +5, he had jumped to 235 so I felt much safer but HATED to see his numbers go back up. By that time, it was 3:00 a.m. and I was exhausted. I got up several times more doing the night to check on him and he was fine.

This morning, he tested at 233. Based on the high-carb food I gave (5 x more carbs than what I regularly feed) and the Karo, I suspect he went higher last night and is coming back down. As several of you mentioned, 68 is great and I would have been so excited if it weren't for his typical pattern of continuing to drop for 8-12 hours ps. Since he had dropped that low, so fast, I freaked out - especially since it was so late and I know many cats drop more at night.

Again, thanks for being there!

 

[Kelly and Buddy]

Welcome to the group!

By any chance, did you get any additional tests after your +4 of 68? If this were my cat, I would have kept testing. You might want to look over the sticky on "Shooting & Handling Low Numbers."

Lantus works best if dosed twice a day. It's a depot type of insulin (there's a sticky note describing what the depot is and how it works) which means this is a very different approach to dosing than a shorter acting insulin like Vetsulin. When you skip shots, it has an effect not only on the cycle but on the depot, as well. It would make much more sense to reduce the dose so you can shoot twice a day.

You do need to get syringes. With cats, you need to have greater flexibility with dosing and with the pen, you can only shoot in 1.0u increments. We make dose adjustments in 0.25u increments. Getting syringes that are marked in 0.5u increments will allow you to adjust your dose in finer amounts.

By any chance, did your vet(s) test Buddy for exocrine pancreatic insufficiency (EPI)? The vet would have gotten an fTLI (feline trypsin-like immunoreactivity) test. This is a link describing EPI. One of the cardinal symptoms is weight loss and not gaining weight despite eating. Treatment involves adding a pancreatic supplement to your cat's diet.

If you don't already have one, a timed feeder may be very helpful, especially once you are back at work. It gave me considerable peace of mind to know that my kitty had access to food when I was at work.

I will have to get a copy of his lab work. I know she checked something with pancreas because she was afraid that might be why he was having trouble with every food I had him on; she put him on a pancreatic enzyme but I'm pretty sure everything else looks fine. I will double check to see if she actually did the fTLI test.

 

[Sienne and Gabby (GA)]

Chances are if she was checking for pancreatitis, she ran an fPLI.

If you didn't happen to notice, there's a tab on the spreadsheet where you can enter Buddy's labs.. When people want feedback on labs, often a pdf or other uploads are often hard to read. We created a tab so the values are accessible to everyone. If you want to take a look, Gabby's labs are on her SS. I routinely have my vet give me a copy of all of cat's labs/test results.

A couple of FYIs... High carb food/Karo are metabolized pretty quickly. I think you're right in that seeing that 200+ number, you were good to go to sleep. However, there's no way to know how to interpret your AMPS number until you see some additional data this AM. If it had been earlier in the day/evening and you wanted to steer Buddy's numbers a bit more gently, testing every half hour until you see numbers that are pretty stable at above 60 is a reasonable goal. Ideally, you are keeping numbers in the "greens" but not so low that there's no margin for keeping your cat in safe numbers. It takes a bit of practice.

The late in the cycle drops are likely due to a bounce that's breaking. It is a good thing but it can be tricky when that drop is at shot time.

Also, keep in mind that vets get unnerved by numbers we look at as safe. They are not used to people who home test and understand what the BG test results mean. Vets tend to like to see cats in higher numbers so the vet doesn't become liable if a cat becomes hypoglycemic. Frankly, there aren't a lot of vets who have cats that go into remission.