Rooh follow up after hypo

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Jmeli

Jmeli

Member Since 2014
SS has been updated except for the following
I gave him 1 tsp of EVO dry at 8:00Pm and followed that with 1 tsp fancy feast grilled gravy after reading 45 with the AlphaTrak2. Tested at 8:15 pm and he is up to 60 from 45 on the alphatrak2 meter.

He was not showing any symptoms of hypo and wasnt even hungry but ate when i offered it to him. He is calm and a little sleepy but this isnt abnormal for him, he always acts like that.
 
Are you at +10 now? What does the 84 on the spreadsheet mean?

Your goal is to get him over 68 on the AT. If you have any sugar syrup, please give him a couple of drops of that on one bite of canned food, or another tsp of the gravy. Sugar syrups can wear off quickly but it should also pull him up quickly. the gravy and food last a little bit longer.

Go easy with the total volume of food - a teaspoon or so at a time is enough. you don't want him to get full and refuse to eat. Restest every 20 minutes or so.
 
Just checking back in, Mel. The dry food should be kicking in before long and will help sustain him a little higher, hopefully. Let us know what's happening. Referring to the info below - with an AlphaTrak, 68 is the equivalent of 50 on a human glucometer. Use 68 as your line - you want to get him above it.

Also, you may need to skip the next shot and you definitely need to reduce the dose with his next shot. Let's see where he is at shot time, but definitely do not shoot the 4.0u again.



I wanted to give you the directions for handling low numbers:

DON'T PANIC! or HOW TO HANDLE LOW NUMBERS
First, try to not panic.Post to the Lantus Insulin Support Group or on the Health Board. Make sure your subject line indicates you are concerned about a possible hypo and/or add the 911 icon to the first post in your condo. People who are experienced in dealing with low numbers will be there to help. After posting, remember to refresh your browser periodically to see if people have replied.

It’s important to recognize that just because your cat may be experiencing low BG numbers doesn’t mean that your kitty is critically hypoglycemic. Many cats will have low numbers and never have symptoms. It’s important, though, to bring those numbers up into a safe range. ALWAYS make sure you have a stock of test strips, high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties (see Dr. Lisa's Cat Food Nutritional Composition List for a full list of options), and/or a simple sugar solution such as Karo/corn syrup, honey, maple syrup, etc.
If your cat is experiencing symptoms, especially if those symptoms are severe, you need to rub Karo syrup, honey, or maple syrup on the gums or, if symptoms are very severe, administer rectally and get your cat to the nearest 24-hour emergency facility. Take the bottle of syrup with you to administer on the way if necessary. (Note that it is rare that we see episodes of symptomatic hypoglycemia with Lantus and even rarer to see severe symptoms. But, you need to know what to do should they occur.)

The symptoms to be concerned about include but are not limited to:
  • staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
  • ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
  • disorientation (yowling, walking in circles, etc.)
  • twitching
  • stupor
  • convulsions or seizures
  • coma
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only.
    (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.

Please post your numbers. Those people who are helping you will not abandon you. In fact, they are staying up with you. The experienced people will even work in shifts to make sure your cat is safe and you have the support you need. Remember to refresh your browser to see new posts and keep posting so we know all is well.

~ written by Sienne and Gabby





*** Suggestions made are intended for use with the Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats ***
​
 
54 was on relion meter (my daily use meter) 84 on alpha trak (backup for low numbers). I have karo but thought gravy might be better? I gave 1 tsp gravy after he his 45 on the alphatrak. He shot up to 72 relion / 143 alpha trak now. I will go back to only using relion meter now at these numbers.
 
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Thanks Julie, I'm not panicked :) and thank goodness I felt like taking a nap today - Im wide awake . He never acted hypo and for a split second I considered not treating until I saw he hit the 45. I think he bounces a lot and maybe he has been hitting low all along and i just havent caught it even though i test like crazy.
 
45 on an AT is pretty low.

I'm glad you're doing ok - i think i was worrying for you!! :)

I wouldn't be surprised if he's been hitting some low numbers either. Often when we see 500's and 600's those are bouncing numbers, caused by a cat getting really low. He's on a fairly large dose and with large increments of increases.

What + time are you at right now? ie, how long til your next shot time?
 
Mel

He is coming up but it doesn't mean he won't come back down. You don't have the data to shoot such a low number.

You can:

--stall without feeding, check every 30 minutes until you see a faster rise. Shoot the new dose (see below). Test to be sure he isn't coming back down and make sure he's going up.

--shoot a half dose

-- skip and let his depot drain.

I was hoping you had dropped back the dose so we definitely know 4u is way too much for him. Although we normally only take a .25u reduction, I still think he should be at 3.5u and see how he does.

Keep in mind that if you stall or shoot a reduced dose, you still might see an active cycle because he has a pretty full and large depot which can affect up to six subsequent cycles.

Thoughts?
 
I agree about dropping his dose farther back when you do next shoot a regular dose.

Marje has given you the options for tonight - he might bounce, or he might go right back down. I'd probably err on the cautious side.
 
Excellent. Skipped shot = zzzzzzzz so try and get some sleep.

Good luck with the reduction. If you are happy with your shot time, just shoot on time tomorrow morning. However, if you wish to change your shot time, you could easily do it tomorrow.
 
Hard to say. The bigger the dose, the larger the depot but ECID. The depot from a higher dose can affect up to six subsequent cycles in some cats.
 
he may be really high again in the morning from reacting to the low numbers + a skipped shot. don't let it freak you out - he'll come back down again once things stabilize.

good job keeping your cool with the low numbers! just like a pro! :D
 
Question - So about dipping down to 50 last night, I looked at my journal and the only thing that was done different is for the first time I accidentally gave his shot in the same spot 2 times in a row. Does anyone have any experience with that causing a reaction?

Also, this week I have been forcing him to exercise a little because he literally barely moves all day/night and has no interest in playing. He stays in one area of the house (by choice) and only moves 15-30 feet a few times a day. I work from home so I know he isn't moving around. Keep in mind, he is not overweight, he is actually under weight.
 
Great job with Rooh last night!!

Giving the shot in the same spot 2 times in a row shouldn't have that sort of affect. More likely, that 4.00U caused a breakthrough; you are getting closer to a good dose for Rooh; and he really starting to respond to insulin. True, he bounced way back up today, but hopefully you'll start seeing less of that. Hold that reducie, Rooh!
 
lethargy could indicate a few things
- not enough insulin, so energy can't enter the cells; is glucose running high?
- diabetic ketoacidosis - are you checking for ketones?
- other illness; any signs of that
 
Now that i think real hard about it, he did start slowing his activity down a few years ago (is 14 now) but got even more sluggish just before he was FD dx.
 
Has he been checked for arthritis? They do move a lot less when they have low grade pain.

The best way to see if by x-ray.
But you can push on his shoulders... hips... back.... to see if he reacts at all.

But lack of a reaction doesn't mean he doesn't have it..... mine didn't react to being pushed on..... but the x-rays showed a lot of it all over her body
and everything improved, including her bg, when I started treating the arthritis.
 
rhiannon and shadow said:
Has he been checked for arthritis?
Click to expand...

rhiannon,

Actually he did see a chiropractor for several visits early 2014 because his lower back was hurting him when touched. She said he probably did have some arthritis but no xrays done. He got all better after several adjustments. What kind of treatment do they do for arthritis?
 
Personally, I used adequan injections for my GA Civvie, Mario....it worked miracles for his arthritic hind end. Cosequin and Dasuquin are supplements that many use; they didn't do anything for my Mario, though. The adequan really loosened him up.
 
Update - spoke with Roohs vet today who recommended he see a specialist. I have mixed feelings about seeing a specialist right now so we may hold off a week or two. She did put a call into one of specialists at the hospital and that dr. recommended i keep him at 4u for the next 24 hrs and test hourly to see if he is having a symogi swing. hmmm... I have mixed feelings about that too. If you look back on his ss history he almost never goes back down for a few days after having hit 100's (so it may be pointless to do it), plus he starts almost every morning out above 600. So he is either definitely swinging or the insulin just doesn't last long enough. I could use some fresh point of views here if anyone wants to share their thoughts. I did shoot 3.5u this AM.
 
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IMO, 4.00U is too much for him, as you found out yesterday. The combination of the big drop and the skipped shot led to the bounce you're seeing today. It can take up to 72 hours for a bounce to clear, so I would hold the 3.5U for a few more cycles to see what Rooh can do with it. He still may need more juice, but I'd rather find that out safely and systematically than risk a true hypo event.
 
I agree with Amy. Those were significantly low numbers yesterday, so i would definitely stick with the 3.5u until we can see what he gets to when he clears the bounce. In my opinion, you don't need to check hourly, but it does look like Rooh doesn't stay long in any lower range, except for last night.

Looking at yesterday, he went from 377 to 146 in 3 hours. Just dropping that quickly can cause a subsequent bounce. A cat doesn't have to get into low numbers to cause a bounce - it can also be from any range they aren't used to. More on bouncing here.

Punkin had arthritis, which is a typical side-effect of acromegaly. Although many cats that don't have acro also have it. We used the adequan too - that seemed like it helped. You start out with frequent shots and gradually spread them out. We also gave him buprinorphin twice a day as a pain killer. We tried acupuncture with mixed results, although at first it seemed like it really helped, but he was so afraid of it i stopped the appointments.

Here is a reference to Somogyi from the Tilly's Diabetes HomePage. This is the same protocol we follow but has some different wording. The section below is under "Increasing the Dose" the last paragraph:
Be aware that experimental studies in human diabetics over the last 15-20 have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists. Therefore, adjust the dose as described above, focusing on the nadir: don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy!) hyperglycemia.
​
It's possible that your vet is referring to rebound, or what we call a bounce. It does look like Rooh is bouncing but that isn't very likely to resolve in the next 24 hours. Bounces can last up to 3 days. However, because Rooh didn't go up in dose per the protocol, starting at a fairly low dose and increasing in increments of 0.25u or 0.5u depending on the nadirs, there is still a possibility that he is overdosed.

If he were mine, I'd probably hold this dose for the next 3 days, test every 4 hours or so and see if there are some lower numbers in there, and see what happens in the next 3 days when he clears this bounce. He may clear it sooner, or he may take the whole 3 days from last night to clear it.
 
Somogyi...in theory....are the swings caused by a chronic overdose. So even if Somogyi existed, which there is no evidence that it does, I'm confused why a specialist would have you leave him at a dose that was causing Somogyi i.e. A chronic overdose. Again, if Somogyi existed, the way to get it to stop would be to reduce the dose.

When we were new, I saw a specialist sho told me the same thing as well as the fact that Gracie was not disbetic and I was "killing her". Thankfully, the amazing people on this board got me through that.

Rooh is telling you he needs less insulin.
 
Marje and Gracie said:
I'm confused why a specialist would have you leave him at a dose that was causing Somogyi
Click to expand...

That was my thoughts too Marje, it didnt make sense to me, especially since if he rebounded he has to clear it and it could take days. o_O

So everyone here says stay at 3.5u for now. But since it sounds like i might be overdosing him, should I also just consider starting over at 1 unit with .25u increments? And if i did start over would i start the new dose immediately or withhold all insulin for a few days to clear out the depot?

FYI I did stick with 3.5 this pm.
 
I just tested him at +2 pm shot. He seems to be coming down pretty good tonight as well and I did give the shot again in the same spot as the two yesterday for no other reason than it was most accessible the way he was lying. The spot being the crevice just behind his left armpit where the arm connects to the body. Coincidence maybe..but I log almost every shot location and every time i have shot near that area, they always work better than the others.
 
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