Not sure what to do - advice please!

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JenElliot

JenElliot

Member Since 2011
Mali vomited a little bit twice this afternoon and didn't eat much for dinner. I didn't give him his insulin shot (Lantus 0.6 unit) after dinner time. I have been unable to home test him because the only way I can do it is by distracting him with a tiny bowl of tuna juice, and he's been turning his nose up at it. I'll try to test again before breakfast/am shot time, but if I'm not able to should I give him his shot anyways? Even if he doesn't eat much? His numbers have been on the low side lately too. Could skipping 2 doses in a row make his numbers shoot up when he's on such a low doseage?

Background: Diabetic for 5-1/2 years, did well with regular vet checks and no hometesting. He was eating mostly dry food until about a month ago when he lost a tooth and we switched to wet. We didn't realize how much of an impact the diet change would have and he wound up having a seizure (rushed him to the vet, numbers were low). His insluin doseage was reduced by nearly half (from 3.5 units to 2 units twice daily). I started home testing (still not perfect at it, some tries don't work out) and his numbers were quite low. I reduced his insulin little bits at a time and we are down to 0.6 units twice daily. At this dose I'm still getting low numbers (usually around 95-105 after eating/before shot, then dipping as low as 65). Before his seizure he was twitching, and he has continued to twitch since we brought him home from the vet, but it has been much milder and less frequent. But the continued twitching has made me very paranoid about not letting his numbers get too low. Could the twitching be a permanent side effect from the seizure?

I'll call my vet tomorrow but any advice tonight would be much appreciated. He seems to be feeling ok, he's curled up into a ball sleeping on my bed. I'm hoping it's just a tummy ache and his appetite will be back tomorrow morning.

I'm also very curious to hear anyones experience with a cat after a hypo scare, especially if they had any lingering symptoms (like twitching) or extra sensitivity to low BG levels. Thanks!!!
 
I am not an expert, but I will tell you what I would do if Mali were my cat. Because of his lower numbers and not eating, I would not give any insulin. I would try to test in the AM and go from there. Twitching could show some neurological damage. Do you have any urine sticks to test for ketones? Donna
 
I don't have any urine sticks, but I'll probably pick some up next time I'm at a drug store - good thing to have on-hand. I'm leaning towards skipping the AM shot even if I can't do a test, all the reading I've done says that higher numbers are better/safer than low numbers, at least in the short-term.
 
I agree with Donna. No insulin since her BG numbers are down. My cat had vomiting fit 2 weeks ago and stopped eating and drinking- which is very unusual for her. Took her to the Vet who gave her the whole treatment ( Ultra Sound, Blood Spectrum, Sample to the University for Analysis) and she was diagnosed with a treatable liver parasite and cystitiis. Cystitis is common eough in diabetic cats and is remedied with medication. Vet put her on temperature lowering and anti-biotic medicine and she is right as rain now. Except for the near Hypo last night which I now have under control. It is best to let your vet will advise you when you see him/her. Dan
 
I'd get the ketone test strips today, if you can. You never know. Ketones can be very dangerous and need immediate care. I've hear the recipe ketones is not enough insulin, inappetance and/or infection.
 
UPDATE: I was able to test him and he was at 141. He grazed a little more throughout the night on dinner (ate more than half of his usual amount). This reading of 141 was about 21.5 hours after his last shot. It's a huge relief to know that his BG isn't getting high. I'm going to skip his am shot as well and test again to make sure he's not getting too high. I'm planning to pick up some urine strips tomorrow, and will absolutely call my vet to discuss everything with her.
 
UPDATE #2: I talked to my vet for quite a while this afternoon and gave her all the info I've collected/observed for the last couple of weeks and she told me to stop giving insulin (YEA!) and continue to monitor his BG. She said to spot check him and call back in a couple days with my readings so we can figure out where to go next. I tested shortly before dinner and he was at 123. :) I'm going to get the urine strips by tomorrow and start testing that regularly too.
 
is there any chance you can get the urine ketone test strips today? yes BG numbers are lovely, but the not eating thing is very concerning, it would be good to rule out the possibility of ketones asap. have seen cases of cats in DKA where BG is not high because at is not eating (and other reasons). a cat no longer needing insulin after 5 1/2 years, even with the diet change, and the hypo, well just makes me nervous that there is a sudden loss of appetite and i just would feel better if we know for sure there aren't any ketones. yeah yeah there probably aren't but if it is~ every minute counts and would need to get to nearest ER. so easy to rule out with a simple 12 dollar bottle of urine test strips.
and even if ketones are negative, a vet visit if appy doesn't pick up is imperative. felines cannot go long w/o adequate calorie intake. a full work up (including x-rays) would be needed to find out why this is happening.
keep trying to entice kitty to eat, try every trick in the book. lightly warming food, opening new cans, different flavors/brands, sprinkling parm cheese or dust from treats on food, tuna juice poured over food, whatever you can think of, try. monday is too far away (esp for a cat that was on insulin for 5 1/2 years) to go without eating (and no insulin) and not knowing why.
and everyone might not agree with this but if the food switch was difficult and your cat just isn't that impressed with wet food, i would go ahead and offer some of the old favorite dry food if you cannot get to vet until monday and cat continues to barely eat anything.... having to give small insulin shots is easier to deal with than life threatening hepatic lipadosis.
~jojo
ps. yes there have been cases where an OD'ed cat suddenly went into remission after a hypo, can happen (not saying that a full work up to look for other cause to not needing insulin after being on it so long is not needed, especailly since not eating). and the neurological damage from the severe hypo, well it is hard to say if that is going to last forever or if you will see continuing slow improvement, it could go either way, no one can say.
good luck, i hope appy picks up and kitty is eating like normal very very soon....
 
Thanks for the concern jojo, I'm happy to report that his appetite at dinnertime was quite good/normal. And he seems to be feeling better too - purring, playing our little game of peek-a-boo, etc... :) I think he just had a little stomach bug that has passed now. And he did eat some food before, just a much smaller amount than usual. No matter what I will get those strips by tomorrow so I can check for keytones.
 
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