Newcomer with hypoglycemic cat Malkovich (stable but not improving after 3 hours)

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BelleC

BelleC

Member Since 2023
Hello all,

I hope I am using this site correctly, I have read through as much as I can and want to be as helpful as I can, but I have only today set up my profile/signature/spreadsheets.

I am the new Cat Care Coordinator at a non-profit cat rescue in the USA. We have some experience with diabetic cats (the director has experience) but we are by no means experts.

We recently had an 18 year 10 month old cat surrendered to us (they were adopted from a sister-organization many years ago and we have a partnership to accept all returns into our program, as the sister-org has since closed due to retirement of the director). The cat is a neutered Maine Coon, whose vet had recommended testing for diabetes (at least a year if not years ago?) but the former owner declined and just considered him "pre-diabetic." They returned Malkovich to us because they were moving. We immediately got him tested & diagnosed with diabetes, and started on Lantus 5/3/2023.

We tried the Freestyle Monitoring device twice before it was recalled (both times weren't super helpful) and have done 2 in-house glucose curves at the vet in the meantime and through monitoring have gotten him to 3U Lantus AM + PM (due to schedule of our rescue and lack of experienced fosters to take him in, it's more like 9am and 6 pm).

He has been stable at this dosage for the past few weeks, but I must admit we have NOT been testing his blood glucose before injecting, as the vet didn't feel it was necessary. It has been very difficult to get blood from him, so they thought it was better to monitor. Reading through everything here, I am realizing that was a mistake.

Today, he got his insulin around 9am. The cat care attendant who gave it to him said he didn't eat a lot of breakfast before getting the shot. Then, about 2-3 hours after his AM insulin dose, Malkovich was stumbling, lethargic, limp. One of our cat care attendants noticed and they then took a reading and it was 44. They immediately gave him Churu by oral syringe and he perked up a bit, so they sat with him and continued feeding him Churu & dehydrated chicken treats. Then 1 hour later he was stumbling, fell over. I took a reading and it just said LO, took another thinking I didn't have a big enough drop of blood and it said LO. I rubbed Karo syrup on his gums a few times and he was more alert, ate 2 TBSp Party Mix. I tested 20 minutes later, still LO. I gave 5mL Karo syrup by oral syringe and 3mL Churu. 30 minutes later the reading is still LO.

Now he is still lethargic. Our usual vet who we text about urgent issues is closed for the 4th of July weekend. We can and will take him to the vet, but we are not sure if we're at that point.

Is there anything we are missing? What can we do?
 
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LO on your meter, looking at the documentation available online, means a BG of 20 mg/dL or lower. If he’s been that low for multiple hours with symptoms of hypoglycemia, I think he needs to be at the vet urgently.

You can also try posting with the 911 tag in the Lantus section of the forum—you might get a faster response from experienced members.
 
Okay, thank you so much. We just tested again and it's 337. Does this mean that we gave him too much Karo syrup/carby treats?
I'll post this on the Lantus section too.
 
A few things to note for going forward. Churu and LC treats are no good in a below 50 scenario. Between 70-90 fine, but below 50 you need high carb. We call anything below 50 a take action number. At that point, please make sure to give high carb food like Fancy Feast tuscany for example. Dry food is not good because it takes too long to actually bring the bg up. Karo and or honey are great but as they quickly bring the bg up the effects also go away quickly. The most likely reason you’re seeing the super high number now is because he’s bouncing. It’s the body’s normal reaction to protect itself from when it goes too low. It's a kitty's self defence mechanism. Here is the description:

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

the main thing I’d recommend is that you need to lower the dose moving forward. It’s hard to say by how much if you have no previous data but I’m thinking maybe go down to 1 unit if you can start to test him and then it can be increased gradually later. What type of food is he eating now and how often? Smaller meals throughout the day can help avoid big sugar spikes and also slow down his bg drops.

Also note, he may have been stressed out with his current situation and at the vet for the curves which means the numbers the vet saw may have been higher due to the stress

btw, who gives up an 18 year old cat because they’re moving??! My heart breaks for him and thank you for taking way better care of him than his previous guardians who couldn’t even be bothere to treat his diabetes :mad:
 
Thank you so much.

I've been reading up on the good high carb/medium carb foods, and will get some FF for future events. I'll assemble a Toolkit too with everything we need.

I have some data that we logged on our forms that I haven't yet transferred to the SS I made for this message board. I'll add that in when I have a moment so there's more complete data.

He eats Hill's W/D Dry; Purina D/M dry and is essentially free-fed, though he gets about 1/2 cup of each per day and just grazes. He is a social eater and tends to eat when people go sit with him, but also eats throughout the day/night some. If I'm understanding correctly, it's preferable to give him controlled portions and not free feed?
 
So the take action number in a pet meter is actually 68. Most of us here use human meters since the test strips are way more economical and we’re all used to interpreting those numbers. The libre is a human meter so if you want to save money, no need to use a pet meter at all.

any changes in his diet lately? 9am and 6pm is not ideal especially today. Any chance you can push his evening shot? An earlier shot can act as a dose increase sometimes and with his hypo, I’d try to avoid it today of at all possible tagging a few more experienced folks here @Marje and Gracie @Bron and Sheba (GA)

If you post a few pics of him here and in the FB group, who knows, you may find someone who wants to adopt him and give him the love he deserves in his last years :bighug:

And I just want to say, great job for acting quickly. You and your team saved his life today.
 
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I have been working with our cat care attendants to do his shot first thing in the morning and last thing at night. It's been a bit of a struggle, as the schedule of our rescue varies per day/some cat care attendants are more on top of it than others/etc. So some days he gets his shot at 8:15am and 7pm, but others it's more like 9pm and 6pm. On the days I can stay late, I've been doing them around 8pm. Is this amount of variation in the shot timing harmful? I can work to get them closer to 12 hours apart, but I'm not sure I can get them completely consistent day to day.

For tonight, we are planning to skip his insulin. Tomorrow, I was going to come in and test his BG before making any decisions about his insulin. The vet is unfortunately still out until the 5th, so we can't ask the vet any questions until then. I don't want to give him his usual 3U in the morning/evening tomorrow and risk another hypo event, but I also don't want to adjust his dose without talking to the vet... any recommendations there?
 
Again without a lot of data is hard to tell. We do dose adjustments based on how low a cat does at a 12-hour cycle, vets based them on preshots but as you saw from what happened today, that’s not the safest. You need to know how low a dose is taking your cat. With Lantus, you have about 2 hours from the shot time to get him eating. You want to make sure he eats always around shot times. Does he tend not to eat like this morning and did he seem nauseated? Is he eating okay now?

I asked about diet changes because switching from a high carb to a low carb diet can significantly drop the bg, by as much as 100 points and we never advise doing that without testing. I def think he needs a reduction and normally we’d say by a 1/4 units but I don’t know what his bg has been like or how fast the dose adjustments have been done. I assume he started on 1 unit and has been upped to 3 by the vet based on the curves. We often see here dose increases by vets that are not warranted especially because cats are stress out at the vet, not to mention being rehomed. That’s a major stressed! we also don’t adjust by full units as you risk speeding right past the ideal dose. If you think he could be tested about 4 times a day and you’re willing to set up a spreadsheet for him, we can help. Vets always push for pet meters when that’s not really necessary and they tend to prescribe expense prescription foods that are too high carbs for diabetic cats. Most of us here use Walmart’s ReliOn meter that costs about $9 and 100 test strips are about $18. This is all to say they the advice you get here will likely differ from what your vet will say when he’s back in the office. I think skipping the shot tonight is fine but I would go at least back to whatever his last dose was before the increase to 3 units.

With a diabetic cat you need
  • A low carb wet diet that is 10% carbs or under. Most of us use around 4-7% carbs but don’t switch what you’re feeding now without home testing first
  • A suitable insulin such as Lantus or Prozinc which are long acting, more gentle insulins than the old insulins.
  • We recommend hometesting the blood glucose with a human meter…it is not necessary to use a pet meter which is expensive to run and is no better. It will keep your kitty safe and you will know how the dose is working for your kitty. Only testing every so often will not tell you what is happening in between those times and an awful lot can happen in even a day.
  • HELP US HELP YOU has information about the spreadsheet, signature and hypo box which you should make sure you have from now on.
We are happy to help you with setting up the spreadsheet, sorting out what food to buy, how to transition safely to a low carb diet, how to learn to home test and much more.
 
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Ale & Bobo & Minnie (GA) said:
Dry food is not good because it takes too long to actually bring the bg up.
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Not actually true. Dry food will work fine to bring a cat's blood sugar numbers up. The down side is that they will stay up longer than with high carb wet food or karo/syrup/honey. When a cat reads below 40, I would start with karo/syrup/honey for a quick boost.

The W/D dry food is too high in carbs for a diabetic cat to eat as a main diet, though works fine to boost him. It's possible that he's been eating enough W/D dry to counteract the too high a dose of insulin. And when he didn't eat for a couple hours, that got him in trouble. For now, don't change his diet until you have a handle on testing him regularly. Side note, we had one person here get a cat from a rescue that was on 13 units of insulin and eating W/D. He looked like a basketball cause he had to eat so much food to stay safe. When he went onto wet food, his dose was closer to 1.5 units.

Is it possible for you to test him again now? I want to make sure he is still high enough and give some more data on what to suggest as a dose tomorrow. Carbs can wear off and the cat's numbers can come down again. Typically we like to see a couple tests in a row of higher numbers to say he's safe. By the way, we have a number of people here using the Freestyle Libre on their cats for the majority of their test data, if testing is too much of a challenge at the shelter. You'll be able to download data and see how he does overnight when no one is there.
 
I missed your reply about the food. I agree with Wendy the dry is likely what’s been keeping him safe at the 3 units dose. I’ll defer to others about free feeding. Smaller meals throughout the day are ideal but I’ve never free fed my diabetic cats so I wouldnt know the answer to that @Wendy&Neko ?

low carb wet food and/or low carb dry food is what would be best for him but do not change what you’re feeding before getting the libre or home testing every day because you could have a repeat of what happened today
 
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Fat isn't a factor in what a diabetic cat needs, it's carbs that matter. The three main components of food are protein, fat, and carbs. As one percentage goes down, the others will go up.

This post has some tips to help with testing: Hometesting Links and Tips - includes numerous links, instructions, pictures, & videos
 
Wendy&Neko said:
Fat isn't a factor in what a diabetic cat needs, it's carbs that matter. The three main components of food are protein, fat, and carbs. As one percentage goes down, the others will go up.

This post has some tips to help with testing: Hometesting Links and Tips - includes numerous links, instructions, pictures, & videos
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I meant carb for some reason I typed fat :nailbiting: fixed. the question was about free feeding though
 
Okay, I just tested him again and he is at 417. He hasn't really eaten for the past few hours except maybe a bite or two of his food. He's mostly been laying in his bed– alert when we go in, but still low energy/fairly lethargic. Is it recommended that we give any insulin tonight, since it's high?

In general, he is a good eater. He has no teeth, so he's fairly slow at eating. But he tends to eat in the morning, he is a social eater so the first thing he does when anyone goes in his studio is to walk over to the food bowls and eat. It was fairly atypical for him to not eat well this morning, but I don't believe he had any obvious signs of nausea/other signs that he wasn't feeling well.

I updated the SS with this and also added the only other day with good data points from his blood glucose curve at the vet. This was after we got to 3U AM+PM and they tested him on this day to make sure this was a good dose. Before that, we had tried 2 separate times to use the Freestyle Libre 2 monitor. The first time, we think we were using expired/bad insulin so it wasn't working at all and then the sensor died after like 7 days. The second time, the sensor was defective and giving incorrect readings. After that, the vet said they were recalled, so we couldn't apply one again. Are they available again?

He has been eating the W/D and D/M dry since he got here. He seems to have only eaten dry food his whole life and I do know it's possible & ideal to switch him over to wet, but we thought it was more important to keep him consistently eating than attempt that. After we are able to test regularly, I will make sure we switch him over to a better diet... For dry, is the D/M recommended? I will also try to get him eating wet food (I'm so glad to have found Dr. Pierson's guide to switching "dry food addicts" over to wet on this forum!). What brand of wet food do you all recommend?
 
If you can’t monitor him through the night and he’s not eating, it’s better not to

It’s important that he eats, yes. As far as I know, the only 2 low carb dry foods are Dr. Elseys and Young Again Zero Carb. You could try one of them and see if he adjusts but you’ll need to monitor his bg closely when you transition. When it comes to wet, it varies. My cats will only fancy feast so I’m stuck with that. Most folks here I think feed either FF or Friskies but you can go high end with brands like Ziwipeak, Tiki or Weruva. As long as it’s low carb, it’s fine.
 
If you aren't already, I would start testing him for ketones. With a cat that is throwing ketones, you do not want to skip insulin at all. You probably could have given him at least a token 1 unit dose.

To test for ketones, you can get Ketostix, or equivalent, at most human pharmacies. Tips to catch and test a urine sample
Ketones can be early warning signs of DKA, but can be treated if detected promptly. Lethargy and not eating enough food are worrying. More information on this post: Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

Doing a curve at the vet can be a waste of time and money. Many cats will reflect the stress of being at the vet by showing higher blood sugar numbers. Note, I had a non diabetic cat that tested over 220 at the vet, and 53 at home the next day. You don't want to decide on an insulin dose based on artificially inflated numbers. Which is why we are advocates for home testing. Even being at the vet I see he got a 183 at the end of the cycle. I'm surprised the vet kept him at 3 units with a number like that, given that there wasn't home testing at the time.

I hadn't heard of the Libres being recalled. There is apparently a Facebook group on using the Libre for pets. Some people even apply them on their own. If you do want to look into them some more, I can find some links of posts people have done on them.

The DM dry isn't very good, it's still too high in carbs for a diabetic cat. Note, the name is dietetic management, not diabetic management. As for wet food, the best food is the one that they will eat. I never fed Friskies or Fancy Feast, but a number of people here do. If a cat has kidney issues, Fancy Feast is higher in phosphorus, so not a good choice for kidney cats.
 
We have not tested for ketones! He did not have ketones in his urine at the vet in June 2023. I also am reading through the medical records included with his surrender form and he did not have have ketones in urine in 3/2023 nor in 9/2020. I'm not sure when he last went to the vet before this (no records sent to us), but at that visit in September 2020 the vet suspected he had diabetes, the owner declined bloodwork, and they recommended he start on the W/D as a "diabetes management diet." So he's been eating the W/D for 3 years... I believe our vet also said that the W/D was an appropriate diabetic management diet, when we had him seen in May 2023 and properly diagnosed.

I will get ketostix tomorrow and test his urine for ketones!

I definitely hear what you're saying about the curves at the vet not being the most accurate. We tried to do our own curve at the rescue and struggled to get enough blood for accurate tests... but I've since definitely improved on my technique after watching videos & practicing, and I think we can manage in house testing/curves again.

I would however also love to hear any recommendations you have about the Freestyle Libre! I looked it up a little and it seems there may be supply issues? I'm not seeing that it was recalled either; that was what I believe the vet said last time we asked about getting one applied. I would also definitely want to learn how to apply them on our own! I know humans apply their own, so I can imagine it would be quite manageable for us to do.

I'm looking at the Food Chart... DM is 6% carbs, which I would have thought was an okay amount as it's under 10%. Is lower than that preferable?
 
One additional observation. It sounds like your shot times can vary widely. With Lantus, shooting early can function like a dose increase whereas a late shot works like a dose reduction. This is due to the way Lantus overlaps between doses and how the insulin "depot" functions. While you have some flexibility, a shot that may be 3 hours earlier than the previous shot (i.e., at +9 vs +12) may have also contributed to the low numbers.

It would be best if your team was able to stick to a 12-hour routine until you have more data on how Malkovich responds to Lantus. Even if you do need flexibility, 3 hours is going to be problematic and likely problematic for any insulin. Also, if the shot is early in the AM, shooting late at PM doesn't make up for the difference.
 
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Bron and Sheba (GA) said:
Are you feeding the wet or dry DM?

The Hills w/d dry food is 37% carbs. I can't imagine how a vet could possibly say that the w/d dry was a 'diabetic management diet'.
The canned w/d is 26% carbs
We do have some people here who apply the Freestyle Libre themselves to save money.
Here is a link to information and tips for using a freestyle Libre
Click to expand...

We are feeding the W/D dry and the D/M dry. He came to us eating the W/D Dry. I can't believe the dry is 37% carbs!

And thank you! I will look into applying the Freestyle myself.
 
Sienne and Gabby (GA) said:
One additional observation. It sounds like your shot times can vary widely. With Lantus, shooting early can function like a dose increase whereas a late shot works like a dose reduction. This is due to the way Lantus overlaps between doses and how the insulin "depot" functions. While you have some flexibility, a shot that may be 3 hours earlier than the previous shot may have also contributed to the low numbers.

It would be best if your team was able to stick to a 12-hour routine until you have more data on you Malkovich responds to Lantus. Even if you do need flexibility, 3 hours is going to be problematic and likely problematic for any insulin. Also, if the shot is early in the AM, shooting late at PM doesn't make up for the difference.
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Okay, thank you! I will definitely look at how we can make a 12 hour routine doable.
 
We have a lot of testing tips that can help you like warming up the ear before testing and always aiming for the sweet spot

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Okay... his BG is at 191 this morning. I don't know how much insulin to give him, especially since today is a holiday so the schedule technically calls for no one to be here until 4pm for 3 hours for dinner/evening meds, so we don't have as good of monitoring as we normally would. I will come in and stay to monitor because I don't want him to be hypo again with no one here.
 
No shot last night and he's 191 this morning? Could you either put 0 or NS (for no shot) in the units cell for last night, so we know you didn't give a shot vs not entering the data yet.
 
Another Q, how long since you’ve had him there? I’m wondering if his bg is going down as a result of getting over the major initial rehoming stress and as he settles into his new normal. I feel like he def doesn’t need 3 units and may just need a small dose moving forward like 1 maybe less as you also transition him to low carb food
 
Cats who have had a systematic hypo can also be more sensitive to insulin afterwards. Could be seeing some of that too.

If you could get a test later on today, that could prove interesting and help us with dose suggestions. I presume you didn't shoot this AM.
 
Hi all, after the test of 191, the director of the rescue recommended we try 2U so I gave that and then +2 hours after the reading was 475 (updated SS). His appetite has been good/normal this morning, eating both the WD and MD. He is more agitated today with the ear poking since he’s feeling better so I’m wondering if the higher bg just now is partially because he’s more angry?

We’ve had him since early May- he’s definitely used to the space now/more settled since rehoming. He has a condo/studio style set up in a 4x8 foot room with a heated bed, a water fountain, volunteer visitors daily. He even plays sometimes. But he did get the last curve done at the vet, so that stress would have elevated the numbers.
 
The BG would not be that much higher from stress/anger. I can think of a couple scenarios that explain it but not sure which it is. If you could get a test maybe a couple hours before shot time tonight and post it here, that'll give us time to work on a strategy for tonight.
 
Ale & Bobo & Minnie (GA) said:
I don’t agree with your director I’m sorry to say. 2 units could still be too much and no one is around to test him today.
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What dose would you have recommended?

Also, even though it is a holiday I have been coming around. I came to test & give insulin then left for 2 hours then came back to test which is when I got the 475. I’ve been here for an hour now with him. I’ll make sure he isn’t unsupervised for more than 1 hour— I know it’s not ideal but I’m trying to make it work.
 
In high numbers, if he stays there, you don't need to be on him every hour. Maybe test again in a couple hours, and if still high he's OK until that test a couple hours before PM shot time.
 
I should also say— we didn’t give him the Gabapentin this morning. Was that a mistake?
 
When you’re starting this journey and not yet sure how the cat reacts, we typically advise that if you get anything under 200, you give a token dose which is 15-20% of the regular dose. 2 units is more than half. That’s on a human meter and you’re using a pet meter which registers higher. He could be bouncing now from the lows. And yes, you don’t need to test every hour once you get a high number. Those lower blue preshot numbers are what I’m concerned with.
 
He has been getting Gabapentin for a combo of pain/arthritis and to reduce anxiety for insulin/testing.
 
Tested his pee for ketones! These pics are both from the same stream— taken at 15 seconds. I did the first and realized I captured the photo with the test strip in shadow!

Does this look like trace amounts? I feel like it looks negative, but can’t fully tell.
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I want to say again, thank you for your devotion to him. You’re clearly going above and beyond for this sugar senior and I’m sure he knows it.

his adopters may have let him down, but he’s sure lucky to have you on his corner :bighug::bighug::bighug:
 
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Thank you so much! Reading through everything here, I am realizing how much I didn’t know about caring for a cat with diabetes. I wish I’d educated myself on it sooner but I’m grateful to you all for helping me out now.

I just got a ReliOn meter & strips! For the spreadsheet, should I start a new Sheet with the Human Readings template? Maybe this question is better asked in the Spreadsheet section?
 
BelleC said:
Thank you so much! Reading through everything here, I am realizing how much I didn’t know about caring for a cat with diabetes. I wish I’d educated myself on it sooner but I’m grateful to you all for helping me out now.

I just got a ReliOn meter & strips! For the spreadsheet, should I start a new Sheet with the Human Readings template? Maybe this question is better asked in the Spreadsheet section?
Click to expand...
It will be a lot more cost effective for you guys being a nonprofit and all! Don’t let your vet give you crap about it and if he does, you can gently remind him that the Libre is a human meter too ;)
 
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Okay- we just got our +10.5 reading. 340 on the ReliOn Premier Classic. The ReliOn seems like it requires more blood than the iPro Pet and I had a hard time getting enough blood for a reading.

Do you all have advice on insulin dosage to give tonight?
 
Is he eating normally again? Are you giving his shot now or at 12 hour mark? I don’t know that I feel comfortable with 2. I think until we have more consistent data, I’d prefer to err on the side of being safe and I’d prefer 1.5. If you could do a +2 after the shot tonight it would be helpful but I know you can’t.

make sure you’re warming the ear enough. It should be warm to the touch. You can also try to milk it to get more blood out. I also always liked scooping up the blood onto my clean nail and testing from there.
 
He is eating normally again, yes! I am giving it at the 12 hour mark, in about an hour. I wish I could do a +2, but I don't think I can.

I agree I'm worried about 2U too... I will plan on 1.5. Thank you for the advice about getting more blood out! I have been holding it between my thumb & finger and rubbing, but maybe I wasn't doing that enough tonight. He was a little agitated tonight and I was alone at first, so I wasn't able to hold it as long as I normally do. But I will try that!

What do you think about using an alcohol swab to rub the ear first? I know alcohol can pull blood to the surface, but then you have to totally dry it right? If there's some alcohol still on his ear & it mixes with the blood, will it affect the reading?

Fortuitously, we do have the vet coming in tomorrow for rounds on all the cats. We'll be discussing with her about home testing, getting the Freestyle Libre 2 back, his diet, and so on.
 
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