Possible hypoglycemia incident and no appetite :(

Status
Not open for further replies.
H

Hillary

New Member
Our cat's about 16 years old and was diagnosed with diabetes around february last year. His insulin dose has gone up a couple of times and he's still very hungry and very thirsty most of the time. Except for today, he literally hasn't eaten a bite and had been so drowsy. Because he was just lying down, he lies down alot, we just figured he was sleepy but after it'd been too long and he'd been so quiet which is very out of the ordinary we got so worried. He also could hardly move and stumbled when he did. He's not great on his feet from the diabetes and from age but this was ten times worse. I suddenly thought, Oh my God is this hypoglycemia?! And after looking up the symptoms it sounded like it, I read to give him honey or sugar but wasn't sure how, how much. He's never had it before so we weren't sure what to do or what to look for. We basically should have been much more prepared! We also hadn't been told how vital it is for him to eat before his insulin, we'd been told to try to feed him around the same time but not that it wasn't an option but vital!. He usually eats before or afterwards but obviously today he didn't so that must be why :sad: .

It's new years eve so it was hard to contact anyone, we ended up getting in contact with someone my dad knew who knows about cat diabetes and he seconded that he needs some sugar, explained how to give it etc, I dissolved half a teaspoon in water and he drank some of it then he perked up a bit and moved around a little but still wouldn't eat. Tried different things, his usual wet food, some cooked turkey, some liver, some dry treats but no luck. Then he got all sleepy again and we panicked. We managed to get him to a 24 hour emergency vets (not our regular vet, but they took their details). For some reason he perked up alot in the car on the way. They checked his blood and his sugar levels were completely fine, she was surprised since he'd only been treated orally because they'd said previously he might need a shot of glucose. Anyway his blood sugar levels are in the normal range so he wasn't classed as hypo by that stage, I'm not 100% sure he was but I'd assume, they said it sounded like it. They also checked his kidneys and thyroid, his bladder and bowels, there was some blockage which could be because he's not been outside to go to the toilet but she gave him an anti emetic shot since he'd been sick in the morning and said his stomach might be upset so he's not hungry. They said he's quite dehydrated too but that's common for his age and a symptom of the diabetes. He's drinking loads though he always does.

I know we should have been more prepared for this, it was scary and upsetting seeing him like that, so we need to be so much more careful with his routine. There are a couple of things that are concerning me right now though;

- Since he's been home he's still been quiet and had no appetite but he seems happier and much more alert. He's not walked much but since he's been so staggery and dizzy all day I'm worried about him trying to climb the stairs, he slipped down one earlier and I had to help him up. I know they've told us his blood sugar levels are ok now but could they drop again and how do you tell?
-When he wasn't well just before he saw the vet he'd look like he was going to sleep but didn't look tired, just completely out of it, so I tried to keep him distracted. Is that the wrong thing to do or not? He seemed to brighten up and look more lively when i picked him up and just walked him around but whenever he lay back down he'd go very, very drowsy again. Is that a coincidence or do you think there's a reason for it?
-I'm not sure how to tell when he's just tired or if he's going hypo again. How can you tell if he needs some rest or if he's going into a coma? I'm just keeping a close eye on him and seeing how aware he looks, he's resting now but when I go up to him I get a little meow so I think he's ok. Is there anything else I can do to check how he is?
*P.S. if his appetite isn't back tomorrow morning we're taking him back to the vet and keeping him off the insulin as instructed.

Thanks very much for reading, sorry it's so long and all over the place!
The information on this site has been very helpful so far so thank you for that.
 
Okay breathe, I know this is scary and you still may not be out of the woods yet, so first things first...you are going to want to read over this and probably print it out and put it somewhere that you can get to it quick if need be.
http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=1122 That will give you the signs of Hypo to watch for and how to treat should he still be going too low.

Secondly once you get through this one, and from what you have written it sounds very possible that he was having some signs of hypo. I'm going to encourage you to start testing him at home, just about everyone here test their cats BGs at home at the very least before each injection to make sure they are high enough to safely give insulin to. Any human glucometer will work, you don't need a special "pet only" type. We test by poking their ears and getting a very small blood sample. Home testing is really the only way you are going to know for sure if he is going too low or just tired and wanting a nap.

This will give you an idea on how we go about testing our kitties.

http://s138.photobucket.com/albums/q270/Kittys14/Videos/?action=view&current=100_0241.flv

Some other questions that folks are going to want to know so we know how better to help you help your baby is:

What kind of insulin he is on? What is the dosage?
What have you been feeding him?

I'm sure others will be along shortly to help out as well. Just hang in there.

Mel, Max & The Fur Gang
 
hi there and welcome.

the board is going to be a bit quiet tonight because of the holiday so let's see what we can figure out for you.

can you tell us what kind of insulin he is on and how much do you give each time?
also, clarify that you are not giving any more insulin tonight right?
then, can you tell me if you are in a bigger city or more of a rural area? i ask because there is a way for you to know his glucose levels at home but you need access to a store that is open at this hour. if you have access to a pharmacy, either walgreens, rite aid, cvs, even target, kmart, or walmart, you can go there and get a glucose meter (same we humans use) and you prick kitty's ear to get a blood sample and a glucose level. is that something that is doable? (if you can get hold of a meter, we can give you more help on how to get a sample)

as far as eating, at this point it's just important that he eat moreso than what he eats being good for his diabetic condition soooooooo, do you have any tuna in the house? sardines? canned salmon? anything you know he likes but you've taken away since he was diagnosed? you can warm stuff up in the microwave also for a few seconds as that makes the aroma of the item stronger, even wet cat food. if you go out to get a glucose meter, grab some all meat baby food. kitty's will often eat that. there's tons more tips and tricks too and i hope someone else is around to help with all the possibilities.

oh, if his tummy is upset, you can give 1/4 of a Pepcid AC 10mg pill. it has to be the regular Pepcid AC, not the Complete version.
 
Hi Hillary,

Sorry you have had such a scary time with your boy tonight, but I'm glad you found the FDMB. I've been here a year and have learned so so much. Please keep checking back for more info, and keep posting- you will be so much better prepared for the next crisis.
There is so much to say- but one of the biggest thing you are asking is "How do I know what his sugar level is?" And the answer is that most of us here test our cats blood multiple times per day so we know how much insulin to give, and whether our cat is experiencing a hypo event.

There are many articles available to help you learn this fairly simple technique. This is a link to our HEALTH LINKS viewforum.php
and it has a topic about hometesting your cat's sugar using a human glucometer. If you live anywhere near a Walmart, you can buy a Relion glucometer (~$9-10) and test strips ($20) and start testing tonight....

It sounds like your cat is not well regulated since he is eating and drinking and peeing A LOT normally. When he stopped eating tonight, his insulin needs suddenly dropped. He may have stopped eating because of something called pancreatitis which is common in diabetic cats. I give my cat 1/4 tablet (2.5mg) of Pepcid AC regular strength, every day for this condition.

If you click on the spreadsheet link near my signature, you can see the ss that most of us use to record and track blood sugar readings and insulin doses. Please dont be surprised by the large doses my cat uses- he has a condition called acromegaly- which means his insulin needs are much much larger than a normal diabetic cat.

After you do a lot of reading on all the health links, post again and tell us a little bit about you and your cat, what he eats, other furbabies, etc. It might help us help you further. Welcome! :-D
 
Did the E.R. vet check for ketones? Administer any fluids?

How long ago did you give the last insulin injection (also what type and how much)?

How long after giving the sugar water did the vet check the blood glucose?

Finally, did the vet check the electrolyte levels?

As Cindy said, if you can get to a store and get a meter, you can monitor the BG and at least answer the hypo question. You don't want to be giving sugar if the blood glucose is normal or high. Pock up some ketostix when you can -- they will allow you to monitor for ketones in the urine.

Many things can throw a cat off their food, and dehydration can make them feel really punky, so it's good that you went to the E.R. If you don't see improvement by tomorrow, I think you're wise to head back again -- better safe than sorry.

Please keep us posted.
 
Thanks so much for the quick responses I was also expecting it to be quiet here at the moment. I've looked at the links about home testing. He's sometimes very difficult and sometimes very calm but I guess if he's got used to the injections ok then he could get used to one extra prick? If it'll help him it's worth trying. I'll look into where sells them here I'm in the UK so it's actually 4.30am right now lol, but I do live in a big city so I'm pretty sure some places will be open a bit later. The insulin he's on is caninsulin and he's on 4 units a day just once a day. His last injection was, gosh, around 17 hours ago now, we just took a while to notice his reaction. She didn't mention ketones, she just tested his blood for glucose levels and just felt his organs, bladder etc, took his temperature and weighed him, it was just sort of general checks nothing else related to diabetes was mentioned except for glucose.

His diet isn't great, it's how I found this site trying to see what food is good for diabetic cats. He's not been put on any special diet so he's just been eating felix senior cat food. From what I've read he needs more fresh protein, I'm cautious about changing his diet too much too quickly because I heard it can affect how much insulin he'll need. But the vet also said about just feeding him anything he'll eat right now and strong scented foods, I'll try heating the food up to see if it helps him to eat it, I hadn't thought of that. Because he'll sniff the food and maybe lick it a little but hasn't eaten yet. They gave us some "sensetive" cat food to try him on too so we'll try him on more options and see if any work.

Thanks again for such detailed replies.
I'm just gonna soak in the information for a minute and see what we can do.
 
Just wanted to pick up on a couple of points. Insulin is normally given to cats twice a day. This would mean initially splitting your dose of 4 units into 2 shots of 2 units each. However, with his lack of appetite and no home testing, combined with the fairly well known hypersensitivity to insulin after a hypo, I would be reluctant to give any insulin until you have tested and get an idea of what his blood glucose is doing in the morning. Others will have more experience with respect to a dose for the morning, but I wanted to caution you about giving him 4 units at once in these circumstances.

i really hope that you are able to find a glucometer tomorrow (well, today for you) and start getting some numbers. It really is the best thing that you can do for your kitty - and you so that hopefully you don't have to go through this again.
 
In case you are wondering ketones are a sign that a cat is very sick, and it is smart to check for them especially when you notice they seem "off". Testing involves wetting a thin paper strip with fresh urine, counting 15 seconds, and matching the color to a chart on the bottle. In the US 50 strips cost about $11. It also works if you dip a strip into a puddle before it soaks into the litter. Some strips test glucose and ketones, some just test ketones. The strips here are called ketostix or ketodiastix. Heres a link http://hocks.com/hocks-healthcare/hocks ... strip.html

I would NOT change his diet until you figure out the blood glucose testing for the reasons you mentioned. but eventually you may be able to reduce his insulin needs if you switch to canned food only.

When you buy a glucometer, be aware that the real cost is in the strips, so you may want to inquire about which models have more affordable strips. If the strips are reasonable, you will be more likely to collect the data regularly. The Hocks link above will show you some of the diabetic supplies available so you know what you are looking for at the store.
 
He's started to look a bit spacy again, I got him to drink some water but he was struggling to even stand up fully this time. I keep thinking is he just tired or is it his blood sugar, when he rests he's just putting his head down not lying down properly like he normally would. I think he should maybe go back to the vets it doesn't sound like they checked much since he seemed a lot better at the time. Can they check for ketones and pancreatitis at the vets?

Yeah I heard that 4 units is a lot, her reasons for giving him just one shot a day was because he's quite nervous but that was also a lower dose when he started. He is due an appointment with his regular vet just with it being closed for the holidays we can't book until they're open again, there's a lot I want to check with her though.
 
Since we don't know what his blood glucose is, or if he was tested for ketones, and his behaviour is not normal, I would certainly be tempted to take him back to the vet. You might want to ask specifically about testing for ketones. Was he given fluids the last time? Perhaps ask about fluids too.

Testing for pancreatitis is probably a good idea, but perhaps not so much an emergency as the immediate problems.
 
Hi Hillary from the other Hillary on the board. I'm in NJ.

A couple of things that may help as well:

- if you give him canned food with gravy and concentrate on giving him mostly the gravy, that will bring up his BG's better than sugar. As the sugar will only bring him up for a short time and the gravy will keep him higher longer. What you need to be be careful with is to not overfeed, as he will get full and won't want to eat especially when you need to bring up the bg's, hence giving him mostly gravy and not the food itself.

- you may want to look into using a different insulin. caninsulin is not the best insulin for cats and there have been recall concerns with this insulin.

when you get past this crisis, please come back and let's talk about other insulin options that you could look into - such as levimer, lantus or Prozinc.
 
We took him to a second emergency vet today and they seemed to know so much more than the first place. They mentioned what everyone here mentioned ketones, pancreatitis, tested his urine and did more thorough blood tests not just glucose. Unfortunately the problem doesn't seem to be diabetic at all but kidney disease. They did mention how certain things from his diabetes could have been affecting his kidneys which they've not got the results back from yet. He's getting treatment right now but it's all up in the air they don't know how he's going to react to it. Sorry about the confusion but thanks for all your help anyway.
 
Thanks for the update. Many of us have or have had kitties with multiple concurrent illnesses along with diabetes, including kidney disease, chronic pancreatitis, heart issues, and so on, so you've come to the right place.

Once some of the results come in, please post back with another update. Charlie juggled many medical issues in his last few years and sometimes it was like a tap dance, but once we identified all of the issues, it was easier to come up with a comprehensive medical plan. He had some good quality time remaining and hopefully your kitty will too.

Knowledge is power. Even though this particular situation might be kidney related, don't feel that you don't belong here. There is a lot of knowledge and experience on this board and we want to help. And of course the original comments still hold true -- you'll want to learn to hometest, want to reevaluate the insulin dose and frequency, etc. -- but let's focus on getting kitty home and back on track first.

I'm very glad that you went back to the E.R. today and hope that your cat is soon feeling better.
 
Hi everyone, I'd been reading your responses and am very greatful for the support. It's just been a very tough few days waiting for phone calls and updates and feeling helpless. Last night we got a phone call saying that he hadn't improved at all and was still suffering a lot with only 5 % chance of improving, and basically prepared us for the end today.

Today it was impossible to get in touch with the vets for half of the day and considering what we were expecting to happen, it was very hard. Finally they got in touch and amazingly he was improving!! Some of my family and I went to see him earlier and he looked so much more himself, a lot more alert and happier. When we got home we got a call with his latest results and they're improving more. Most of his results were off the chart the first test and now he's at normal levels and has started eating a little again.

Interestingly he's not had insulin for 3 days because they say his blood sugar has been at normal levels and he literally hasn't needed it, they're going to keep testing him to make sure he's doing ok though (btw we made a mistake before it's insuvet he's been on not caninsulin). When his diabetes was first diagnosed his vet told us cats are the only animal who can learn to manage the condition alone. So we think maybe his latest problems, especially the thirst, have been kidney related, which is very, very serious and is going to be a constant worry.

Urgh It's been such an emotional rollercoaster. It's relief that he's doing ok, fear of what's going to happen, last night it was grief, we've been so distressed about his distress going through all of this. I'm trying to stick with being happy he's ok right this minute and take it from there.
 
Glad to get the upbeat report. One small thing that can help with the dehydration issue is to feed wet food and add water. Lots of cats like the soupy type mixture.
 
kidney disease is treatable, totally, unless it is end stage but it doesn't sound to me like that (but not enough details to know for sure).

Please. Do NOT let them change him to a kidney food that is dry food and low in protein unless he is end stage ie dying. The old thought was to reduce protein but it is no longer believed necessary and is actually bad for cats (they will cannibalize their muscles for the protein they need). they need moisture via canned food and possibly fluids, they need a diet moderate in protein and low in phosphorous (ie no fish). you can give phosphorous binders to help reduce the impact of phosphorous.

it may well be that he was/is diabetic but was getting overdosed. please keep careful eye on him when he's home in case he still is diabetic.

Jen
 
The vet said about kidney problems they can go on with it for a while then suddenly crash, that's exactly what happened with him. So we feel very on edge, I know he's not a baby anymore but trying to accept the end was so hard even that one night.

Hmm, they mentioned giving him a specialised food for his condition, they didn't say what kind though yet. I know for diabetic cats dry food isn't good, I would have thought with the dehydration issue they would want him on wet food. When we mentioned diet and an increase in protein they said it could be bad for an older cat. The vet did seem to know quite a lot, he checked everything, everything diabetic and then everything else. When we saw him today the food in his dish that he'd eaten finally (yay :)) looked like it'd been wet food if that's any indication...

I was very cautious about the diabetes and insulin too. They should be keeping up the chekcs on his blood levels to make sure. I think we were all so in shock today it was hard to digest everything.
 
Status
Not open for further replies.
Back
Top