Recurring Hypos

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Jandy100

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Hi, we've had Jet since he was a kitten and he's now eleven and a half years old. He's had diabetes for probably about six years now & we've always managed it well.

He started out on Insuvet, but they no longer make it, so now we're on Caninsuliln.

He's been on it a few months now, and has 9 units twice a day.

(He's a big boy, just over 6kg)

He really has only had a couple of hypos, up until this month, when he's had four. He goes all spaced out and wanders around sniffing and trying to get into corners. We tend to give him some tinned food, and if that doesn't work after a while, some Glucogel.

He seems to be eating the same amount as before, but the main change has been that we've got a new kitten. Kimba loves him and follows him everywhere!

He's off to the vet on Monday for a Glucose curve (he was due a check up anyway) and will talk to them about it, but we didn't know if anyone here may have some ideas as to why this is happening more often - is it his age?

We're in England and it appears that vets here aren't keen on home testing so wouldn't know where to start!
 
My vet was adamant against home testing. I did it anyway to be able to help Poopy. Good thing, too, because if I'd been dosing Poopy as the vet suggested we would have either had a hypo on our hands or I would have come home to a dead kitty. Neither is much fun. :cry:

So it doesn't matter if they are for home testing or not. Pop on by the pharmacy and pick up a meter, lances, and strips. There's plenty of folks here who can help you through this but you have to have the equipment to start. :smile:
 
9 units of Caninsulin twice a day? :o That is a HUGE dose for most diabetic cats. No wonder your cat is constanly hypoing. I strongly recommend dropping that dose down, perhaps by half, to prevent any more hypos.

There are UK members who do hometest. You don't need your vet's permission to test at all. Just go to the pharmacy/drug store and buy a Human blood glucose meter and extra matching test strips and lancets.

Where in the UK are you? There aer members from all over the UK here. Perhaps someone here can suggest a better vet in your area.

What food is your cat eating? This board recommends low carb canned (tinned) food. There are several good UK brands you can buy, like Felix in Jelly and Butcher's Classic. Here's a list: http://www.felinediabetes.com/FDMB/viewtopic.php?p=230948 But don't change the diet just yet. Doing so while still giving that huge amount of insulin can result in more serious hypos, if not worse.
 
WHOA 9 units of insulin?? If your cat does not have any insulin resistant conditions, I bet you have alot more hypos than you think! That's alot of insuln.

Home testing is done by many others in UK and other locations closer to you; please DO get a regular blood glucose meter, some test strips and lancets, from the pharmacy and you can save a bundle of money by just testing at home. And you may also save your cat's life one day by testing. I have to say that it does NOT hurt, and my cats either come to me when it's time to test, but my big Oliver often just stays where he is and sleeps through my poking his ear tip to test.

I have never understood why vets say don't test the cat's blood sugar when a dr would never tell a human diabetic to NOT test. The person would think their dr was nuts!

Cats do not show much in the signs of hypo and testing is the way to avoid blood sugars too low, and can let you know if your cat is sick and NOT hypo.

Caninsulin is not the greatest insulin but I do know that it's tough for you to get a different insulin. I also know that there are a few people who have been able to get OK from their vets to use Lantus, so it may be a good idea for you to start home testing immediately, and when you go to the vet for the checkup, have a good talk about using Lantus (glargine) instead of Caninsulin which is not that long lasting and works better for dogs but not cats.

One more question: what type of food are you feeding? If you are feeding dry cat food, its high carb content may be what has been saving your cat's life, so don't changed to a wet pate type cat food without cutting that insulin dose in half or even lower dose.

That dose of 9 units of caninsulin is the likely cause of all your hypos.
 
I think this is a case when board members from anywhere would give similar advice. I'm one of the few in the UK and agree with the previous posters - 9 units of Caninsulin is a very high dose indeed, whatever a cat's weight, and as others have suggested, Jet may be hypo-ing more than you think. And I really doubt if it is anything to do with your new kitten!

It's such a shame the Insuvet was discontinued because it's usually a better bet for a diabetic cat than Caninsulin which is really intended for dogs who metabolise it in a different way. Unlike Insuvet, which has a more gentle onset/duration, Caninsulin works quickly when a dose is given and is used up fast (shorter duration), so if you are giving 9 units per dose that is definitely worth looking at ASAP.

Ok, so as for home-testing and vets here not being keen - I'm not sure where that came from, I think vets generally are open to the idea if they can see that you are going to use it properly. That's the key to it - getting the vet to see that you know what you're doing. So this is the very best place to be because you can read up all about it and get step=-by-step help.

Where are you in the UK? There aren't many of us but we can tell you where to get the necessary equipment (mainly online). Basically you need a small kit comprising a glucometer (as used by human diabetics), lancets to prick the cat's ear and get a small sample of blood, and strips to use in conjunction with the meter/blood to give you a reading, which is the information you need to see immediately what the BG (blood glucose) number is at that moment. A curve can be done at home or at the vet's, but the process is the same, so if you can find a way to start home testing that will save you a lot of money.

There is a lot to take in, we appreciate that - thinking about and starting testing can be daunting so start with, but with the right attitude and support you will be just fine. Everyone here was in your situation at the beginning. I think my best advice right now is to read up here as much as you can and talk to your vet about what you have learned, including dosage, testing, and types of food. Meanwhile I really would lower that 9 unit dose - it really is a very high dose indeed and it is better to reduce the dose considerably and let Jet's BGs rise for a short time than drop dangerously low.

Please be assured that we are all here to help so keep writing, ask any questions you like, and have a serious talk with your vet (or maybe ask to see another vet in the same practice)?

Good luck
Diana (in Surrey)
 
Thank you all for your replies.

Jet used to have 12 units of Insuvet. He started out many years ago on 2 and it's gone up from there!

He was originally on ten units of caninsulin, which was reduced to nine three months ago, so - as you all say - it probably does need to come down again!

He's always been fed on the same food - Purina One dry food in the morning and Felix tinned in Jelly (he doesn't like the gravy one anyway!) in the evenings. He's usually after more food at bedtime so we put a little more dry food out for him (probably realises he needs it!)

If anyone has any links for home testing kits we'd be grateful, sounds like that's the way to go. It is expensive - we had insurance but that's reached its £4000 limit so the testing is all out of our own pockets now, which isn't a problem we just want Jet to have his diabetes under control.

It's a shame as we had a vet at the practice that had a diabetic cat himself, so we felt we could talk to him. Jet's regular vet always seems to be concerned with getting his weight down, whereas the others that we have seen say not to worry and getting the insulin right is more important.

I'm not sure what would happen if we dropped the does too low without testing first (say over this weekend before he went to the vets) - does anyone know or think it's a good idea?

Thank you again for your replies

Janine & Andy
Milton Keynes
 
Hate to say it, but it is a high carb dry food you are giving him?

If dry food is a must there are low carb dry foods out there.

This is the effect of dosage the different dry foods have had on my Simba.

w/d high carb dry food (ca 30 % carbs) - 6 Units BID Lantus daily
k/d high carb dry food (ca 30 % carbs) - 4 Units BID Lantus daily
m/d low carb dry food (15 % carbs) - 2 Units BID Lantus daily


so you can see the huge change in insulin needed ...

Hope the others in UK can help you point out better dry food if dry food is a must, and help you lower the dose asap if you change foods
 
One thing for sure: do NOT change the food to low carb until you give less insulin... cut the dose in half or maybe 4units, test at home for the BG numbers, and then change the food to the low carb WET pate type foods.

I don't know what kind of meters are available by you in the pharmacies, but any meter that is used by humans should be good.
 
Some info on how to home test, including a supply list: http://felinediabetes.com/bg-test.htm You can also search youtube for "Feline Blood Glucose" if you want some video how-to's.

Hopefully a UK user can suggest a meter, but I believe the Bayer/Ascensia Contour is available there and is widely used for cats (it's what I use). The main cost here is the test strips, the meters are generally free with the purchase of a bunch of strips or at least very cheap (like $9 here in Canada). The strips can range from $0.20 to $1 each depending on the meter type, the quantity, and the source. It's a long term cost, but you get to save on paying for in-clinic glucose curves and you potentially save big from having to pay for the intensive care a severe hypo attack might require. Plus, it's much, much safer for your cats health.

Link to some info to convince your vet home testing is good: Convert A Vet and more can be provided if they need more convincing. And remember you do not need their blessing or even their permission to home test.

Given that you are having recurring clinical hypoglycemic incidents, reducing the dosage asap seems prudent. Hypo incidents are of a far greater concern than glucose toxicity over a few days time. I am very new to all this but have read many different insulin protocols over the past month and all of them want to avoid hypos. They're short term badness that you don't want anything to do with.
 
Purina ONE dry is one of the worst you can feed to a diabetic cat. It has over 30% carbs :shock: That's like a Human diabetic eating nothing but sugar loaded junky foods. But,a gain, do not change the diet without first learning how to test your cat's blood glucose level and dropping that huge dose of insulin.

Just go to the pharmacy and buy a blood glucose meter. Any good pharmacy will have at least a few different brands. In the US, some big name brands are AccuChek, OneTouch, FreeStyle, and Bayer. These may also be available in the UK. You don't need a fancy high tech meter. A simple basic one that just gives a reading is all you need.

Videos and tips on how to test your cat's blood glucose level: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287
 
Yes... that ridiculously high carb dry food is probably the reason your kitty is still alive right now :(

Drop the dose, start home testing, see where he's at. From there, you can slowly introduce low carb food while testing and tweak his dose. See what you can do about getting him on a more cat-appropriate insulin. Caninsulin is harsh and its duration is short.
 
A note on the Freestyle meter - I wouldn't go with that one even if it is available where you are. It is now also known as the heartbreaker by many of us as it is showing low readings at higher BG numbers.

Home testing really isn't as hard as you might think and is absolutely essential if you want to keep your cat safe. I recommend that you start by rubbing your cats ears and get him used to that - Vyktor wasn't keen to start off with. After a couple of days I added a little pinch to the rubbing. Then I was going to add clicking the lancet without trying to test but he wasn't fussed by the noise so I went for it. The most important thing is that you're relaxed about it, if you are stressed your cat will know it and be stressed too. If you don't suceed the first time you try for the test don't worry, have a piece of choclate and try again later and give you cat a low carb treat everytime you try whether or not you're successful too. It will probably make you feel better if you test yourself first too, then you can see it really doesn't hurt and will be more relaxed about doing it to your cat.

Agree with what everyone else has said about food type and insulin dose. I would be reducing the dose immediately.

Also my vet started Vyktor out on canninsulin but because I was home testing I could see exactly what it was doing to him and insisted that he be changed to lantus.
 
Sorry not to have got back to you earlier, blame BT!

I think that Diana has covered most points. If your cat has simple diabetes, the dose is enormously high, however there is another condition that does need high dosages.
and I'm sorry I cant spell it!!

Insuvet was a wonderful insulin and kept my three healthy. When Bushey Boy came to us, he was on Caninsulin, and I might as well be injecting water!
It might be as well to see if your vet can find a more suitable insulin.

Do learn to home test Glucometers are very cheap on Ebay........ look for One Touch or glucometer. We will help you to do this and it will give you peace of mind. Once you have learnt to do it you can do your own curve (two hourly tests) which will show how things are going.

It is possible that you are passing the optimum dose and you cat is dumping sugar into his blood to counter the insulin, this happens till the sugar runs out and you have hypo!
Do keep glucose powder handy, it can be rubbed on the gums when in hypo. Dont forget, if you feel ill, you dont want a three course meal, so it takes a while before a cat will eat again.
Hope this helps. I will send you a PM with my tel no

Mary
Hastings UK
 
Thank you all for your replies, and thank you Mary for your PM!

We reduced the dose slightly last night and this morning and will make a list of things to ask the vet when we go tomorrow, with suggestions about home testing, different insulin etc.

Will report back as to what they say!

Janine & Andy
 
Weird - I just posted here but it seems to have disappeared!
What I was going to say is that yes, Mary's right, there is a condition called acromegaly and this is very different from 'ordinary' diabetes. My Tom had it. I wouldn't worry about it too much for now but add it to your list of topics to ask your vet about because it is certainly a possibility if Jet is taking so much insulin.

Ref the meters - the One Touch Ultra is a good bet. Look for it on ebay - something like this:

http://www.ebay.co.uk/itm/One-Touch-Ult ... t_716wt_93

They are often sold by human diabetics who don't use all their supplies. I'm not at all sure if they're supposed to sell on ebay but they do, and it's a much cheaper way of buying equipment than going to a chemist.

Good luck
Diana
 
Well - the vet we saw last night was by far the better one we've seen so far. She's american and has knowledge of Diabetes in animals.

She agreed that the dose was probably too high and we hae lowered it to eight for the time being - possibly more - Jet's going in for the day on Monday for them to do a Glucose Curve.

She also agreed about the home testing so we're going to get ourselves set up with that too.

What was interesting is that she told us to inect insulin after he has eaten, as if he has only eaten half of his food, then lower his dose in accordance with that etc. We've always been told to stick to the same dose whatever and do it before food.

Will keep you updated on the progress so far!

Janine & Andy
 
well, that seems a step in the right direction! if you have found a vet you feel you can work with, ask for him/her by name in the future and if necessary put in the odd call between visits - FD isn't an exact science by any means so someone who has more knowledge of a particular case is very helpful.

you're doing well - keep us posted!

diana
 
Jet went in for his Glucose curve on Monday and the vet was very concerned as his figures were 11.something around an hour after he'd has his insulin, but dropped to 1.6 at it's lowest about four hours later.

She said to leave his insulin for a day and not give him any and he had another blood test yesterday, which showed it was 20.

We're now giving him four units twice a day and he's going for another Glucose Curve on Tuesday.

He also had lost a little weight (less than 1kg though), so we'll weigh him next week and see if he's lost more - if he has then the vet thinks she might test him for other things (thyroid etc.)

Will report back then!
 
That's a steep drop in four hours but not untypical of Caninsulin's action. The vet should know how this insulin works - quickly! 1.6 is worryingly low, though, and shows that the dose was too high. It's really not surprising that Jet was showing signs of hypo-ing at that number, poor little boy.

So, on no insulin he was at 20, also not good in the other direction, so I'm glad to hear he's back on insulin - any insulin - and on a lower dose then before.

This is all a step in the right direction as you are arming yourself with the knowledge you need to treat Jet appropriately. It will be interesting to see what the curve looks like on 4 units twice a day.

As to the weight - 1kg is a lot for a cat to lose so I'm glad the vet is going to keep an eye on this. There may be other things going on affecting the overall picture, it's so hard to say with FD.

Good luck and keep us posted,
Diana
 
My baby is on canninsulin as well. We ended up at the ER a couple weeks ago with severe hypo with siezures. That is when we found this site. I bought a home meter and started my own testing. He went in for a curve (he was previously 9 units 1x daily) they gave him 6 units and food. He crashed to 1.3 in 5 hours.

She wanted me to put him down, I said no thanks. So now we are testing pre-food and pre-injection and giving him 1.5 units 2x daily. Get the home meter it is sooo worth it.

Good luck:)
 
We're definately going to get the home monitor, just so we can see what's happening. Hate the thought of having Jet put to sleep just because we/vets can't control his dose, so we'll perservere!
 
Jandy100 said:
We're definately going to get the home monitor, just so we can see what's happening. Hate the thought of having Jet put to sleep just because we/vets can't control his dose, so we'll perservere!
Click to expand...

Once you are home testing, you will see that the dose you have been giving has been way too high and has been causing huge extremes in Jet's numbers.

Human diabetics would never think of giving insulin without testing first, so why would it be OK to shoot insulin into a cat without testing first?

Home testing is quite easy and you will be able to keep Jet safe - you will see if Jet's numbers are too low or not.
 
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