new & SCARED of more hypos!

Status
Not open for further replies.
2

2112

Member Since 2013
Hi all! My guy is "Keller" - 14 yrs, and diagnosed about 5 weeks ago. Here is my question: Some advice, please? Keller was initially put on DM dry and started on Lantus. Recently though, due to some hypo issues, he has been switched to moist food ONLY (no dry treats, either) and NO insulin - which he has been doing for ONE full week now, and I have been spot checking. His BGs are running at ~250 - ~285, and he grazes on moist made available to him all day long. So, I think he still needs insulin therapy, right?
I am SCARED to restart him because he had a hypo that needed ER, and then was taken off inuslin, and another hypo (I controlled that one with food) a few days after that when I restarted him (after 2 1/2 days w/o insulin) - and that was on just ONE dose (our first dose back!) of 0.5u in the morning. He didn't even get to the p.m. dose bc he was at 83. He was also on dry food only at that time. His overall BGs are less than when he was initially diagnosed a month ago, but looks still high-ish, right?
Question is, WHAT do I do now? Start dosing him (I have Lantus) twice a day 0.25u - or less? just a "drop?" - after he eats a little? Now with the wet food (1 can Fancy Feast 3-4x/day), he is eating slower, over the course of hours - and moist food is always available to him. Please help!! Need a course of action to follow.
Also, could his numbers still come down further without insulin and moist food only, or is a week long enough to tell he has settled and still likely needs insulin?
 
Twice a day? (Lantus)
Also, he grazes throughout the day and overnight... won't that screw up my BG reads?
 
Yes, twice a day, 12 hours aprt. Unless you test just before giving the shot and see a number under 200. If that happens, post here for help if needed.
Grazing is okay, but we try to remove food during the two hours before shot time. That way you know that food hasn't inflated the number.
Grazing won't mess up the numbers, as long as you "account for food" when you get a BG test. If he snacked an hour before the test, then some of that number will include an increase from eating.
 
Aha! Thank you! 2 hours before feeding remove food. that, I can do.

And won't dose if 200 or less and will post here.
 
Hi there!

Its good to be a little scared of hypos, especially with your experience already so a lower dose is a good idea. But you should still monitor him closely - it might take a few days before you see him drop, and he may well drop too low again , especially if he is a microdose cat. So be ready with your hypo kit (see below) and read this link http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

If he does drop below 50, then we can discuss how to give 0.1IU. My Bailey is a microdose cat - he literally gets 1-2 drops and 1/4unit would give him a hypo too.

Wendy

IN CASE OF EMERGENCY - YOUR HYPO KIT
Put together NOW the following items and put in an easily accessible place!
Phone number of your vet
Phone number, address and map/directions to your nearest emergency vet (or phone number of the cab company and some cash/credit card)
Karo syrup, honey or corn syrup
High carb canned food with gravy – 2-3 cans
Some favourite treats
Spare pack of 25 blood glucose strips
Coffee for you ;)
 
Ok... we started back on insulin last night. I gave him 0.2u by using the drop system, and his BG was at 343. This morning (12 hours later) he was at 146! I did not give him any insulin. This is what happened before... 12 -14 hours after a shot of 0.5u, he was at 83! And he eats moist food all day long.
I am ending up giving him one shot every 2-3 days! But he needs insulin, bc eventually it goes back up to high 200's & mid-300's. anybody have any idea of what is going on???? I will test again soon and write what it is here....
 
He is very sensitive to insulin effects; some cats are (do a search for DebH and XuXu. He rebounds fast, too!).

You may be able to go with a shot every couple of days, based on the observed drop with a tiny dose. And he may not need it for long. Also, you may find ProZinc, U-40 insulin, may work better for you as it does not build up, it is less concentrated so measuring small doses is easier (using a conversion charg and U-100 syringes), and may be dosed on a sliding scale.

Look for anything else which may increase glucose levels - dental disease, urinary tract infection, bladder stones, upper respiratory infection, and so on. If anything exists and it is something you can control, that will help.
 
Very good information, thank you! Especially, the possible infections. He has pretty bad neuropathy though, and was very symptomatic, although that has now faded.

Shouldn't I feed him the 5% and under carb food, to get him off insulin? I tried no insulin for 8 days - do you think he could have kept coming down in BG reads beyond that or was that enough time to tell?

Here is more info. I looked for a record-keeping panel on this site, but didn't find, so here it is:

My name is Amy, my kitty is Keller. Keller was diagnosed about ~6 weeks ago, and has had two hypos. He was initially on dry DM + Lantus every 12 hours, but after the hypos, I took him off insulin completely and switched to all wet food ONLY - no treats, either. It appears he needs insulin, but what is happening is very, very BIZARRE.
He grazes all day long on very low carb wet food per catinfo.org list - ie, Fancy Feast pate styles, Friskies Special Diet & pates, and moist DM.
Since we have been on wet food only (about 1 1/2 weeks), his overall BG has come down to ~250 -335 at random and before feeding checking. So, I have tried to start him back on insulin, but it doesn't seem to make sense.

The first attempt to go back on Lantus was on May 11, 2013. I gave him 0.5u at 8:23am in the morning after a BG read of 321.
At 2:50pm his BG was 156 (6.5 hr)
At 5:15 his BG was at 83 (9 hr)
At 8:20om (12 hr) his BG was 169. I did not give him any insulin at this point because he was around this number before when he had his first hypo and it fell to 36 in ONE hour after his Lantus shot. It's like his tissues are retaining it much, much, MUCH longer than they *should.*

At this point, I took him off Lantus entirely for one week and continued to feed only moist, hoping he was in remission.
I continued to test him throughout the week without insulin, and his random daily BGs were 250's - 340's.
So, I decided to try insulin again.

Yesterday, - May 19, 2013:
no insulin given this morning (so he had none since 5/11/13 - so has been off insulin completely for 8 days)
11:30am - BG 283
8:01pm - BG 343
8:13pm = 0.2u Lantus

May 20, 2013:
7:56am - BG 146 (12 hr) - NO insulin given!!

Just checked at 1:13pm (17th hr since insulin)... his BG is 83! And it's 17 hours after his shot of 0.2u!!!!!
WTH? I can't figure this out! Just the smallest little bit of insulin (Lantus) is lasting for 36 - 48 hours in him!! But if I take him off completely, it goes back up to 250 - 330 after a few days. This happens even though I feed him more fresh moist (right away each time), it continues to go down for about 48 hours after just one little tiny dose before rising again. He is eating ~ 9 - 11 oz, all throughout the day (always available to him).

One thing about him... he has bad lungs.. - full of mineralization and off margins of his diaphragm and lung lobes. Nobody knows why he is like this (or how he survives), but it is evident he was born this way and it is a congenital defect in him. He has trouble breathing, although his oxygen is always at 95% or above, so he is able to survive (obviously!) He has been this way for 14 years. Could this be why the insulin is lasting so long in him? Do lungs metabolize insulin????

Is it possible a cat may only need a teeny dose of insulin every 3rd day to maintain non-diabetic levels? Because that looks exactly like what is happening with him!

Can anyone offer any insight or similar experience??? I am so afraid to give him insulin, but I think he needs some. But it doesn't appear to have any rhyme or reason as to a regular schedule for him, and how can I give less than 0.1u?????????????????

Btw... He is not symptomatic like he used to be with the excessive water consumption and urine output since he started on all wet food, however, he still has neuropathy, and his BG is too high without any insulin at all!

it's like he's in remission... but not! :/
 
He may have a "sputtering pancreas" that intermittently works. When it does, it drops fast and stays low.

The idea behind slightly increasing the carbs (< 10%) is to provide enough of a glucose substrate that you can regularly give insulin safely without hypo. Giveing the insulin may help rest the pancreas so it can recover function. Note that both protein and fat molecules can be dissassembled into carbohydrates when needed (nifty!)

Funny you should ask about data collection - we have a color-coded spreadsheet with instructions here.
You'll need a Google Account, so if you don't have one, do that first.
 
The BG's need to get under control to help the neuropathy. Also, you can give methylcobalamin, also called methyl B-12, to help with the neuropathy. The cat version is a pill called zobaline which does not have any sweeteners in it to harm a diabetic cat. You may also be able to find liquid methyl B-12 at an online pharmacy. That is the form I am using. Any excess will simply be excreted in the urine.
 
Lantus is a depot type of insulin. This means that the shot you give will have an effect for several days because some of the insulin goes into storage in the body and is not all used up right away. So if you give a shot, and then skip shots, it takes the depot some time, a few days, to drain of this excess storage capacity. Once the depot is drained, the BG's shoot up again.

I think the idea of feeding a slightly higher carb food may help. Most of the Friskies pates are 8-10% carbs. Would Keller eat those do you think?

p.s. Hi Amy and Keller. Welcome to the best place you never expected to be. ;-) Would you be willing to add some data to your user control panel in the upper left hand corner of the screen? Click on that link and then click on the profile tab. Within the profile tab there are several selections along the left hand side. Select Edit Profile and enter your location in the location field. Click on submit to save. This location can be as generic as your country and state/province. We are in all different time zones and it helps to know what time zone you live in.

While you are there in the user control panel, profile tab, would you please update the edit signature freeform text box. This is a place to have such information as your name, your cats name, insulin used, meter used for home testing, food being given, any complicating health issues. Click on submit to save this data. Having this information there will put it at the end of your posts. This will give us a quick snapshot of Keller and help us to help you better.
 
Thank you, Deb. Ok, I'm confused... if I want him off insulin, why raise the carbs so I can dose him? Or rather, why not just dose him 0.1u whenever he gets above 200, which may be every 3rd day? I cannot believe he went from 343 and 0.2u of Lantus to 83 BG 17 hours later with no more insulin! That scares me, and I do not want to dose him at ALL if is under 200, does that make sense? 343 to 83 that much later after a teeny dose indicates that he shouldn't be dosed twice a day perhaps?
It would be difficult to get him on to the gravies and higher carbs now that he has his taste for meat... and then, what if I want to switch him back to the low carbs if he gets off insulin entirely and he won't because he's had gravies and higher carbs?

Frustrated and unsure! :(
 
ok wait a minute... looks like there are some Friskies pates that are over 5% carbs, and that I could still keep him on this pate style and then go back to 5% and under later without putting him off his feed...

So you are saying, feed this, try insulin more regularly, and see if it will kickstart his pancreas? Gosh, then how do I find out if it has kickstarted? Wouldn't I just have to take him off for a few days and test at random?
 
Saw the doc, but I don't have a google account... And I don't want one... :( is this a problem?
 
Ack! Also, went to User Control Panel and profile... uh... I don't have ANY of that stuff, nor know what it is. ICQ? Messenger? Aol? I'm not very computer savvy; I'm sorry!
Tried to upload a pic of Keller, but too big... And sorry, don't want my bday out there... I guess I will just leave it alone for now. thank you for telling me about it though!
 
Ok doky

1. Yes u need a google account
2. Send me the pic (PM me) and I will reduce it for you
3. Don't worry about icq and messenger .. You can ignore those. They are chat features but nobody uses them here.
4. We want to find a dose you can give twice a day to try and keep his blood sugar stable. At the same time we want to give him a low carb food to stop his blood sugar going too high. However you have a range of low carb foods you can give so you could give anywhere between 1% and 10% and it will still help his diabetes. So I would try 0.1iu or 1 drop and see if that works before changing food. However I think we need to see a spreadsheet so we can get a better idea of what's going on here. Lantus can last a long time as it builds up in the cats body so 83 might have been the lowest he went, and if so, that's ok.. Hence we need a spreadsheet and maybe more testing at certain times so we can really see what's going on.

Wendy
 
Your goal should be remission, not simply regulation, not simply keeping the BG numbers below the renal threshold of 230-280 to prevent organ damage.

University of Queensland study found that 70-90% of cats on lantus, weight loss if overweight, low carb diet can achieve remission in the first few months. After that time, the possibility of remission decreases dramatically. Slide show here: http://www.uq.edu.au/vetschool/content/clinic-stlucia/feline-dm.pdf

Another article here: http://www.uq.edu.au/ccah/index.html?page=43391&pid=0

When you skip doses, you are letting the insulin depot drain and are back to square one on your regulation.

Once the depot drains, the numbers are shooting sky high again. You want to be able to find a dose that you can give consistently every 12 hours, same dose AM and PM without needing to skip shots.

Right now your cat is constantly yo-yoing from normal non-diabetic numbers up to the 300's and 400's. That is not giving the pancreas time to heal. Cats are unique in that the beta cells can heal/regenerate and some cats can go off insulin. My foster Wink has been totally diet controlled for 2 months now. Some people have their cats go months and even years insulin free. Isn't that a goal worth shooting for?
 
2112 said:
Ack! Also, went to User Control Panel and profile... uh... I don't have ANY of that stuff, nor know what it is. ICQ? Messenger? Aol? I'm not very computer savvy; I'm sorry!
Tried to upload a pic of Keller, but too big... And sorry, don't want my bday out there... I guess I will just leave it alone for now. thank you for telling me about it though!
Click to expand...

The only field we wanted you to fill out so we could see it on the Edit Profile was Location. Leave everything else blank. Most of us don't use anything else.

The reason I wanted to see your location was to know what time zone you are in so we can help you in the event of an emergency. People on here will stay up all night with you if necessary to make sure you and your cat are safely through a hypo. But to commit to that, we need to know when your 9pm or midnight or 2 am occurs. Providing a location gives us a clue.

You can make it generic like I did, MA north shore area. That bit if information is on my posts, over on the right hand side of the page. From that general location, someone can figure out I'm in the eastern time zone and plan accordingly.

Make sense as too why we like to see a location?
 
ok, got it. Will add location.

:( I understand what you are saying... but how can I do this?? I'm so scared! He goes in the 80's on 0.1u - 0.2u even when it's not built up in his system. What if the higher carb food doesn't work and he hypos again if I dose him every 12 hours even 0.1u? What about his lungs? Oh, I am a wreck!!!
 
Amy, I know you are scared. You don't want to hurt your cat Keller. On the other hand, you want to make him feel better.

Here is a link to a document on deciding to give a shot or not with a low number. http://felinediabetes.com/FDMB/viewtopic.php?f=32&t=61797 I suggest you print it out and study it and then ask any questions you may have.

Here is a second link to a document on dealing with those low numbers. http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=147 Please print this one out too.

Ok, we know that 0.5u is too much. So we need to use a smaller dose. First, do you have 3/10 cc insulin syringes with 1/2 unit markings on the barrel? That will be key to measuring those tiny doses.

I can also provide some pictures of what those tiny doses look like. Let me go find them and I'll be right back.
 
Amy, here are the pictures I was talking about that show those tiny doses.

Pictorial guide using a U-100 syringe marked with half units:

someinsulin-1.jpg

01unit-1.jpg

025unit-1.jpg
 
Since you don't have a spreadsheet set up yet, you can enter the BG (blood glucose) test numbers you do have in your post like this.

5/11 AMPS ? 0.5U +x 83 PMPS
5/12 AMBG ? 0U
5/13 AMBG ? 0U
5/14 AMBG ? 0U
5/15 AMBG ? 0U
5/16 AMBG ? 0U
5/17 AMBG ? 0U
5/18 AMBG ? 0U

5/19 AMPS ? 0U +3.5 283 PMPS 343 0.2U
5/20 AMPS 146 skipped shot +5 83 PMPS ?

What I think you really need to do is get some tests at +1 and +2 to see how fast Keller is dropping.

Remember, do not shoot under 200, do not feed, post here first for advice.
 
Here is another option. Start very very low.I found this technique to give my cat Bailey the least amount of insulin I could. I call it the "empty syringe" Heres how it works..

You need to practice this technique: a syringe, a small bowl of water mixed with food colouring in it, a white plate.

Technique: Practice this... Draw up the food coloured water into the syringe to the 1/4 unit mark. And now inject it back into the bowl to simply empty the syringe.Now go to the white plate with the same syringe and press the plunger very firmly and hold it.. you should get literally one small coloured drop out onto the plate. This is because the plunger is flexible rubber and so there is still a very small amount of liquid in the syringe even though you previously emptied it - which you can use if you press firmly.

Try that for a couple of days but with insulin of course (inject the excess insulin into the sink or something).. and measure often to see where he is.

Set up a spreadsheet so we can watch and advise - let us know if you need help with it.
Have a hypo kit ready so you can see low numbers coming and steer him away from it. But I would be surprised if you will need it on this dose.
Continue to test daily for ketones.

Wendy
 
Hi everyone! I think I have got it under control, and what is happening, is his pancreas is "sputtering" and trying to kick in. - Good news! I dose him (yes - that is the picture I have been using!) 0.1 - 0.2u every 3rd cycle currently. So, 36 - 48 hours pass between shots, and hopefully that will soon extend into more days between shots, and then into remission as the wet food allows his pancreas to heal and start working. I have read from others that have done this one-time "boost" when their kitties are close to remission, and there is no way I can reduce a 0.1u dose. I set the plunger at the 0.0 mark as it is!
The BEST news I am finding about him is - his blood glucose goes DOWN after eating! That means his pancreas is releasing his own insulin and trying to work again! At first, I thought that was wrong, you want numbers to go up; but someone told me no, that was good news! I am very hopeful.

Below is the information I have for him so far. He has been on under 5% carb WET food ONLY for 10 days now (per catinfo. org - so I KNOW I am feeding him the correct stuff).
Here is his log since we re-started insulin:

KELLER'S LOG:

May 19,2013
11:30am......+192...................................283/15.7.....OFF insulin for 8 days
8:01pm.......+8.50..................................343/19.1.....
8:13pm.......+8.75..................................no test......0.2u Lantus

May 20,2013
7:56am.......+11.75.................................146/8.1.....no insulin
1:20pm.......+17.................................83/4.6.....
8:15 pm.......+24................................165/9.2....no insulin
10 pm.........+26.................................126/7

May 21, 2013:
9:40am........+37.25..............................317/17.6......
9:50am........+38..................................no test.........0.2u Lantus......... + 1 can Fancy Feast (& ~ 1/2 can FF to munch on until afternoon meal)
11:56am.......+2...................................201/11.2............
3:56pm........+6....................................69/3.8........ + gave 1/2 can Friskies to graze on until dinner meal
5:59pm........+8....................................124/6.9.......
 
Woohoo!! Come on Keller! dancing_cat Work that pancreas that yo' momma gave ya! dancing_cat

FYI, You don't have to separate the shot time out from the pre-shot test if you're giving a shot within ~15 minutes of a test (it sometimes even takes me up to a half hour after a test :oops: ).
 
:-D Things are looking good! That sputtering pancreas appears to be kicking in, if I'm reading right. All this on just a drop! :o

Thanks for the clarification about testing before shot. I was wondering about that; less confusing to put it all on the same line..
 
Its not ideal the way you work it because he is going high during the interim. As long as he is having higher numbers ie 200+ it will damage his pancreas over time and the sputtering will get less frequent.

Wendy
 
Wendy&Tiggy said:
As long as he is having higher numbers ie 200+ it will damage his pancreas over time and the sputtering will get less frequent.
Click to expand...

She's giving 0.2u whenever he tops 200 right now to see how he handles that.
 
I don't know how I could do it any different, honestly. How would you split or give less than 0.1u?
 
Go up in this thread to Deb & Wink's post and see that picture of microdosing. That is the same pic I am using, and I put the plunger on the 0.0 mark. When I inject him and depress the plunger, I don't even feel it move! But... that little tiny bit IS going in, and affecting him so greatly, I cannot even do it twice a day! I did try it with water though, and yes, after it is empty, I push hard and 1 little bubble ekes out. That is what he is getting. If, for example, I pushed the plunger hard to the VERY end, and then pushed hard again, still a tiny, teeny, smaller bubble would form. To me that is 0.1u. So I call what I give him "0.2u."
I was actually thinking about what half of 0.1u would be, and I guess it would be injecting some insulin in a cylindrical tube or small shot glass, and then just rolling the syringe in it to coat it - but not drawing anything up - and then just sticking it in his skin and pulling it out.
YES, it is CRAZY... he is *that* close to remission, but he STILL needs the most minute, tiniest amount you could EVER give! He stays below 150 for 2 days on that, and he had a hypo when I shot him at 110, so I do not shoot him if he is less than 200. This boy drops BG right after a shot and drops FAST. And a lot!
 
Just like my bailey!! I do recommend you try the empty syringe technique I mentioned above and see how big the drop is, compared to your 0units..

Wendy
 
hi Wendy... I just edited and added more info to my post right above. Read that for more 411... ;-)
 
I write "0.2u," but I believe he is really getting more like 0.1u or 0.15u already. He is averaging one shot every 4 cycles, because I can never give him a second shot 12 hours later after the first, or even 24 hours after, because he is always around a BG read of 80-120, and I am afraid of him having a hypo. Especially since after I give a shot, he always flies down fast like 150-200 points. Yes, I'm afraid it will be too much.
 
Hmm.. Well it's up to you, you I could try a higher carb food to see if you can get a compromise where you can give insulin a bit more often to try and flatten the blood glucose more, and keep the blood glucose down below 250 or so, but not too low!

Or you could look into levemir or prozinc to see if a different insulin could help.

If you can set up a spreadsheet and do a little more testing like the last few days then you could go and post in the tight regulation board and see what they think,, there are some really experienced dosing people there that could advise better on micro dosing.
 
I may do the higher carb food. I just had to shoot him 0.1u bc he was at 249 at +11.75.

What tight regulation board?
 
Status
Not open for further replies.
Back
Top