Newbie.... no insulin on board but BG dropping. Now what?

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Cheri V

Cheri V

Member Since 2016
Gracie was diagnosed last Monday, started on Lantus midday Wednesday. Gracie has a bunch of other issues and periodically stops eating, which she did today just before her insulin was due. I called the specialty vet at CSU -- they said skip her insulin. They said give Cerenia and transdermal Mirtazapine, which is what I normally do to try to get her to eat -- and she did eat moderately. A few hours ago she pooped -- apparently she quit eating due to nausea from constipation (she does that, she has chronic and severe constipation for which she takes Miralax and Cisipride). When that problem was solved, she started eating. And eating. And eating..... But now she has stopped eating, in spite of Mirtazapine on board, and is acting very lethargic.

BG numbers (sorry, haven't made the spreadsheet yet....)
1:00 AM this morning, prior to insulin: 116
1:00 PM prior to insulin: 154 (not eating, DID NOT GIVE INSULIN)
4:00 PM 136
8:40 PM 94

Here's the question: she hasn't had insulin for 19 hours but her BG numbers are dropping, in spite of having eaten like a pig (Mirtazapine induced) all afternoon and up to about 2 hours ago. She's acting very lethargic. Should I be worried about this?

(And I live out in the boonies where the nearest vet currently open is 2 hours drive away.... "take her to emergency vet" is really not an option.)

Thanks for any help you can offer....
 
Since there was no injected insulin for 19 hours, I would not be deeply concerned about hypoglycemia. However, you can continue to test every few hours. If BG gets in the 50-70 range, that is low. If the BG goes lower than 50, that is cause for concern. But that usually is caused by too much insulin.

She is probably lethargic from the food. Our cats are generally lethargic anyhow.

You have some time now. I recommend reading the hypoglycemia links:
http://www.felinediabetes.com/FDMB/threads/hypo-links-be-prepared-just-in-case.48385/

It is unfortunate the hypoglycemic info on FMDB doesn't list a table with blood glucose values and their meanings.
 
Thank you! I read the hypo material before, but I just read it again to get it into my head. And that is exactly my biggest problem -- I keep testing and getting numbers but they mean nothing to me. I asked my vet, and basically got told "just shut up and give the insulin dose we told you." But I'm beginning to suspect Gracie shouldn't be on insulin at all..... her dose is a tiny 1/2 unit and even that appears to be too much. She's already gotten hypoglycemia once since last Wednesday when she started insulin (fortunately, she was already at the vet's office for IV fluids at the time). I'd rather not do that to her again.
 
Cheri V said:
Thank you! I read the hypo material before, but I just read it again to get it into my head. And that is exactly my biggest problem -- I keep testing and getting numbers but they mean nothing to me. I asked my vet, and basically got told "just shut up and give the insulin dose we told you." But I'm beginning to suspect Gracie shouldn't be on insulin at all..... her dose is a tiny 1/2 unit and even that appears to be too much. She's already gotten hypoglycemia once since last Wednesday when she started insulin (fortunately, she was already at the vet's office for IV fluids at the time). I'd rather not do that to her again.
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It's very frightening when they go low! Having been told by my vet to give one unit twice a day (under no circumstances change her dose) And not test (not recommended) if I hadn't tested or known about here is have had a very expensive emergency trip to the vets! Or gone to sleep and had a dead kitty in the morning!

So I feel your pain. I was told they can't hypo with no insulin on board. So I think she should be fine.
You could reduce the dose perhaps?

The numbers you have are not numbers I would shoot at but I am using a pet specific meter.
 
With those numbers she does not need insulin. Do you know if they did a fructosomine test to diagnose her? If not then I suspect that her higher glucose readings were caused by either pain or possibly an infection. Vet stress will also cause BG to rise considerably.
 
Thanks Elizabeth, I had lost that link - it has a good table.

Cheri - 1/2 unit is not much. If you Gracie is below 200, the advice on this forum is to generally not inject if the kitty is under 200. I agree with Lisa, at those numbers, Gracie may not need supplemental insulin.
 
JeffJ said:
Thanks Elizabeth, I had lost that link - it has a good table.

Cheri - 1/2 unit is not much. If you Gracie is below 200, the advice on this forum is to generally not inject if the kitty is under 200. I agree with Lisa, at those numbers, Gracie may not need supplemental insulin.
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Thanks! That's exactly what I need, some specific advice on what to do with these test numbers I'm getting. Today I tested right before her shot was due and got 218. I have a suspicion about what is going on... I think she eats the other cats' high carb dry food in the night. Maybe if I really control what she eats, she won't need insulin.
 
Cheri V said:
Thanks! That's exactly what I need, some specific advice on what to do with these test numbers I'm getting. Today I tested right before her shot was due and got 218. I have a suspicion about what is going on... I think she eats the other cats' high carb dry food in the night. Maybe if I really control what she eats, she won't need insulin.
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Hi. Any chance of you setting up a spreadsheet? It makes it easier to advise. What type meter are you using? On a human meter 50-120 is normal. Once you gave enough data we shoot at lower numbers but you are not there yet. On an AT pet meter the low is 68 as pet meters read a little higher. How was it determined that insulin was needed? I ask because stress can raise the BG when at the vet for many cats. A few actually drop but not a lot. I see Gracie has lymphoma and is on pred. It can cause diabetes sometimes. Sometimes once used to it they go back to normal. It helps also to link yiur previous post to the new one. I'm going to go back and try and find them.

What are you feeding her?
 
I know how hard it is to deal with multiple cats and their different foods. We found that we have to keep our 4 cats separate during mealtimes. Most cats will adjust to a change of schedule in time.
 
Hi Cheri - we pull all food up 2 hours prior to testing, so no one gets to snack. But the high carb food can definitely interfere with good readings.

218 is borderline. And all glucose testers have a 20% variance, including the human testers. That means a test of 200 could be between 240 (200 + 20%) - 160 (200 - 20%)
 
JeffJ said:
Hi Cheri - we pull all food up 2 hours prior to testing, so no one gets to snack. But the high carb food can definitely interfere with good readings.
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I really need to put some thought into how to do this. The dry food is out all of the time because one of my other cats has IBD and MUST free-feed -- I almost managed to kill him off once when I tried to implement a feeding schedule to put one of the others on a diet. When I'm around Gracie doesn't touch it, but if I'm gone, asleep, etc. she will munch on it.

And I continue to think maybe Gracie doesn't need insulin. That single reading of 218 is the highest she's been since she was diagnosed last Monday. Maybe she just needs less pred and more control over her diet. She was diagnosed with diabetes based on a blood glucose of 390 and a couple of UA's, plus the fructosamine test. There was a "perfect storm" leading up to it -- I had to leave town unexpectedly to care for my mother, the cat sitter fed her Friskies and didn't notice she lost a pound in 10 days, she got horribly constipated (cat sitter didn't notice that either) which made her nauseated which made her quit eating which made her more constipated so when her blood was drawn that had the blood glucose of 390, she was at the vet having 4 enemas in a row..... My poor baby Gracie! She's better now.
 
Poor Gracie! That does sound like perfect storm. If someone gave me 4 enemas in a row, my blood would probably boil !

A cat is diabetic if BG is higher than normal over a period of time. A single reading is not a good indicator. Maybe you could do a daily test, and try somehow to keep the high carb food out of the way for 2 or 3 hours. That will be the challenge.
 
JeffJ said:
.....Maybe you could do a daily test, and try somehow to keep the high carb food out of the way for 2 or 3 hours. That will be the challenge.
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All I have to do is stay awake and offer her alternative food every hour or so, 24 hours a day..... Gracie pretty much never stops eating. Her last meal of the day is about 2 in the morning, and she wakes me up somewhere between 4 and 6 AM for breakfast. It's because she can eat so little at a time due to her esophageal stricture. She only eats the dry food if I'm not there offering Fancy Feast the second she wants it. It's a good thing I don't have a life other than caring for Gracie!

Interestingly enough, Gracie's regular vet today said about the same thing. She wants a daily test relatively early in the day. And she said no insulin unless I get two high readings in a row, or one very high (300+) reading.
 
jayla-n-Drevon said:
Have you tried ondansetron for nausea ?
It has been a miracle for us and you may not even need a stimulate ,,,
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I would LOVE to try ondansetron.... I have some for me (great stuff!) so I could easily cut up one of my own pills. But every time I ask my vet says no. She has never used it, and doesn't want to start now. Since I really need my vet, I don't think I can give Gracie anything she hasn't prescribed.
 
Critter Mom said:
@Cheri V -

Maybe show your vet the following document......
.
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Thank you! I will email my vet the link. It doesn't help that the CSU specialty vets don't support ondansetron as a treatment. The CSU vet said it has to be given by injection frequently during the day to be effective, and they are very against me "poking" Gracie (you should hear what she said about home testing!). Since they said that, my local vet has an easy way to say no each time I ask. But from comments on the IBD Kitties group I know ondansetron can be highly effective in pill form. And in my personal experience -- yes, I need injected or even IV ondansetron when I'm in the hospital and desperately nauseated. But the pill form works JUST FINE for that everyday "oh yuck" feeling. I find it very annoying that I can't even try it for Gracie.
 
Cheri V said:
The CSU vet said [ondansetron] has to be given by injection frequently during the day to be effective,
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Piffle. It might be the case for some cats (not heard of any here) but it's certainly not the case for all cats.

Typical dose for a 10lb cat is 1mg q12 but it can be given at 2mg q12 (Saoirse needs the higher dose and gets it daily). I've observed that at the beginning ondansetron may take a day or two to build up its anti-nausea effect but thereafter it's extremely effective. Cerenia works faster for Saoirse but its overall effect isn't as good as ondansetron's and the Cerenia peters out in less than 24 hours in her case (injected version).

I'm sorry to hear that you yourself have need of ondansetron. :bighug: Thank you for sharing a little insight into the experience of actually taking this medication. I find such insights very helpful because Saoirse can't tell me what it's like when she takes it.


Mogs
.
 
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Cheri V said:
I would LOVE to try ondansetron.... I have some for me (great stuff!) so I could easily cut up one of my own pills. But every time I ask my vet says no. She has never used it, and doesn't want to start now. Since I really need my vet, I don't think I can give Gracie anything she hasn't prescribed.
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I give mine to Rico every day and Dre when he needs it-- (before prescribed)
My vet did not know about it either nor has he used (he actually called me Friday with a client whose cat will not eat even with a stim. He asked what I give Rico and then gave a injection of ondasetron and prescribed them oral tablets) I showed him information/he spoke with feline specialists and he now prescribes it. It is much cheaper online.... Rico would probably not be here without it....
Maybe you can show your vet some documented information --
@tiffmaxee probably has some info your vet would respect....
(I also have the injectable and it has a sting to it-- the oral takes about 20 minutes for Rico to work--some cats take 45 minutes)
Rico is 13 pounds and gets 2mg Dre is 20 pounds he gets 4 mg if needed (he doesn't need it much)
Just for reference even Rico cardiologist told me to continue with it as well as the stimulate if needed.
I know it is hard to deal with some vets but there is always new info coming out...Elise > @tiffmaxee is on top of all the new stuff:cat:
:bighug::bighug::bighug:
 
tiffmaxee said:
I'm not home now but will send the link to the article later. Ondansetron has helped Max so much. I use the pills.

Here it is....
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Thank you! I will give it to my vet. Maybe she will prescribe ondansetron.....

I was also especially interested in the reference to transient diabetes in cats with pancreatitis. Gracie has pancreatitis among many other conditions, and was at the vet for constipation and just generally feeling crummy when she had the blood tests that led to her diabetes diagnosis. She had that one high reading (390, from IDEXX labs so that's probably the equivalent of a pet meter) and has not been anywhere near that high since, with or without insulin.
 
Your welcome. Max has had chronic pancreatitis for nearly 7 years. I'm fairly certain it is why he is diabetic now and never went into remission. Many cats n pred become diabetic as well. How was the lymphoma treated? Max did tend to get constipated on ondansetron but just 1/8 teaspoon once or twice daily of Miralax helped. Now he's getting more since he has kidney disease and is on a phosphorus binder. I hope ondansetron helps.
 
tiffmaxee said:
How was the lymphoma treated?
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After much soul-searching I did one radiation treatment -- it's called stereotactic radiation and it is very tightly targeted radiation guided by CT scans. It is so precise it can radiate the tumor but not the skin above it. Gracie was dog and cat #9 in a research study at CSU for a new protocol of this type of radiation for nasal lymphoma. It was amazing! They told me it would shrink the tumor "fast" but I never expected this thing about the size of half a small grape on her face to disappear in about 2 days. The new protocol is so new that they couldn't tell me the expected survival period -- other than the prior protocol had a mean survival period of one year. That was 6 months ago. Sadly, Gracie hasn't done well since for other reasons. She developed an esophageal stricture from her medications, and she has chronic and severe constipation (yup, she's on Miralax -- a LOT of Miralax). The pred keeps her throat open enough so she can eat, and probably helps the cancer too, so she HAS to have it even if it gives her diabetes. I really don't expect her to be around too long, so every happy healthy day I get with her is a gift.
 
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