seizure tonight - now at emergency vet

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underdawg

underdawg

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My cat had a seizure tonight around 10:45. He had no other symptoms today other than a possible vomiting. (With 4 cats, I don't know who throws up when it happens.) I tried to give him some karo but don't know how much got in. I also gave him a packet of Whiskas which he gobbled up. Then we went to the emergency vet and around 11:15 his BG was 74. A week ago his insulin was increased from 3 units twice a day to 4 units twice a day after we did a curve at the vet and all numbers were in the 300s. Have not had any luck home testing. He doesn't want to be tested and cries when he gets a shot. I have to pick him up at the emergency vet by 7:30 in the morning and take him to his vet. I don't know what we need to do. Thanks for your help.
 
Sounds like a hypo and that you thankfully knew to give Karo syrup. I'm amazed he ate food!

Obviously, need to back down on the insulin. Maybe he was stressed out at the vet and that was why there were high glucose levels seen. Can you at least do urine checks for glucose & ketones? Much better than no hometesting at all.

And hooray that he is getting better and can come home. What a scare!
 
Oh my, 4 units of Lantus bid is quite a bit. Even though Bo weighs 20 pounds. I hope he is ok.
 
okay, i'm going to try to give you tips on home testing here:

can you practice testing on your other cats too? maybe that will help? i know it's not easy at first. first you have to get past being scared or worried about doing it (at least i did). but with more practice you will get better and better at it, and it will not be hard at all. i test all my cats once a month so they are all used to being tested.

most important thing is to control your attitude about it because your cat will pick up on that. if you try to make it a happy occasion your cat will begin to look forward to it. i'd get his favorite treats and use a LOT of praise to help him feel good about it. even if the number is high or low, always tell him what a great cat he is. best thing to do is have everything ready and don't put the strip in the meter til just as you're about to poke him.

initially i'd do this on the sofa, with my cat lying against the armrest hemmed in by my leg on his other side. if you can, have a floor lamp or table light shining in back of him so you can see the veins in his ears. other thing is to make sure the ear is warm so it will bleed easier. some people microwave rice in a sock for about 20 seconds to warm it, then put that on the ear. others just rub the ear a little or hold it lightly between fingers to warm it.
initially the ears often don't bleed as easily so it's okay to nick the edge of the vein to test him. just be sure to use a cotton ball to do it, and apply gentle pressure afterward to stop bleeding and minimize bruising. expect to use neosporin or polysporin on the ear every few days or so to promote healing for the first month or two. do the job as quickly as you can -- cats seem to be more irritated at having their ear held for too long.

and initially at least FAKE confidence. if you act happy and like it's the most natural thing in the world to do, it will inspire confidence in your kitty. some people test while their cat is eating. others give a snack the kitty loves. when i started i gave chicken boiled in plain water, and all the kitties looked forward to test time because they all got some too. :)

hope this helps. really emphasizing that it's important to test before every shot and at least one time or two between shots to see how he's doing. and normally we recommend only about a 0.25u increase rather than a full unit increase in dose. if you can go to the lantus insulin support group here and read the stickies at the beginning of the forum, you'll learn more.
 
Thanks for your feedback. I could not believe the site went down last night after I posted! (Sorry about that - it was part of the software upgrade. Still, it must have seemed like a very long 30 minutes! _Rebecca) I will pick him up at the vet this morning and take him to his regular vet. I have printed out a few things to take with me like the shed and the protocol. I just don't know if I should have not started the insulin until he lost some weight. Also I read about changing his diet and how that affects the need for insulin. Got to have a long talk at the vet this morning.

Is vomiting a sign of hypo coming on? I never saw that anywhere as a sign.

He is really cooperative for a while with the home testing then he is out of there after a few pokes with no luck. The problem is with me. We try to have the good attitude, we give treats, etc. It is just getting enough blood! I hope I learn fast for his sake. This is scary! Thanks for all your help.
 
Another thing...

I am sure he needs to reduce the insuiin but by how much now? Since he went up 1 unit last week, do we decrease by 1 now or by the .25? Thanks
 
underdawg said:
Another thing...

I am sure he needs to reduce the insuiin but by how much now? Since he went up 1 unit last week, do we decrease by 1 now or by the .25? Thanks
Click to expand...

You should consider dropping back to 1 unit BID. Unless there are other health issues going on, most cats seem to respond best between 1 - 2 units BID. Most likely you have missed your optimal dose. By starting over and hometesting you can slowly work up to the dose that works best for your cat.

There is a condition called Somogyi rebound that happens when too much insulin is given. In order to protect itself from becoming hypoglycemic, the body produces extra glucose to try to counteract the high dose of insulin. That means that when the BG is tested the readings will be higher. By starting over and gradually over a period of weeks (with at least 1 week at a consistant dose before even considering changing) you will be able to find the optimal dose.
 
you might want to scale it down to 2 units twice a day for 2-3 days to see how he does on that (personally i like to start at 1 unit and then go up or down as i want, but as he's been on a much higher dose i would probably reduce more gradually, and 1 to 2 units is a standard starting dose for many vets).

be sure to pick up some ketone test strips at the pharmacy to test his urine for ketones just in case 2u is not enuf insulin. if you don't think you'll be able to collect his urine, you can put some clean litter in a cup and add a little water to it, then test it with a ketone test strip to see whether you get a positive reading. if you don't, all you need to do next time he pees is get in there before he covers it up, and just stick the strip directly in the wet litter and test that way.

try to check his blood sugar 5-7 hrs after injecting insulin to see how low he's gone (do other spot checks when you can). if you're not seeing any real movement in the numbers after 3 days, raise the dose by 0.25u, and repeat as needed til you start seeing a response (on the other hand, if you get a number 40 or lower, reduce by 0.25u). if you print out a copy of lantus's tilly protocol from the lantus insulin support group stickies (or it's linked in my signature), you'll have a game plan for diabetes treatment. the forum is very active, so you'll get plenty of help there.

you might want to try injecting him in a different area, in case he's just sensitive in the area you're shooting. for example, if you accidentally shoot into muscle, evidently that can be painful. are you using short needles (5/16" long)? that might help as well. walmart and hocks.com both sell U100 syringes in 5/16" length and half-unit measurements. they also sell thinner gauge needles, in case that helpe. i like 31 gauge, as my cat doesn't even notice them.
 
Sounds like emergency averted, but yes, you want to do whatever you can to avoid this in the future. And the best answer is to hometest. Would you want to post your city and state and see if someone lives nearby who can come help?

Are you sure poking in the right place? Get a flashlight and find the vein that runs down the side of the ear. You want to poke the capillaries that run off that vein toward the edge of the ear. If you put a dab of vaseline on the spot, you can see where to poke without the flashlight and it will help the blood bead up.

Are you heating up the ear? In the beginning, lots of cats needs warm ears. A thinnish sock filled with raw rice, knotted, warmed in the microwave until very warm but not hot works well. If you get a bit of blood, you can milk the ear, pushing toward the spot you poked.

It helped us to take the cover off the lancet so we could see better. Are you using a bigger gauge lancet - 29 works well at first. And poke at an angle. And you can double poke at first to make the hole bigger.

Let us know if we can help in any way.
 
I suspect the vet had you increase the dose based on the BG number s/he was seeing at the vet's office. Unfortunately, vet stress increases the BG levels. B.K.'s BG level goes up 300+ at the vets, and even mellow Chester will jump 100+ from vet stress. So, the vet was advising you based on the best information s/he he...unfortunately the best informaton s/he had was elevated past what your cat is "normally."

I use Lantus on both my boys, and 4 units BID is a significant dose. There aren't too many cats here that have 4 units BID as the optimal dose for regulation...it's just too much.

It is important you test. If you are really struggling with testing using the ear, you can use the paw pad. B.K. won't let anyone mess with his ears (it takes the vet and two techs to hold him down, just so the vet can do a routine exam of his ears!), so we use the paw pad. What is most important is that you test, not where you test. Also, when you change your kitty's food to low carb wet, the amount of insulin needs to be reconsidered. As a result of a change in diet alone, the BG level drops (some have reported as much as 100+ drop in BG level from diet alone).

I hope all this is helpful. You had quite a scare last night but, fortunately, you were able to get your cat to the ER vet and it sounds like your kitty will be fine.
 
Thanks! I use 5/16 31 gauge needles. I have got to use the ear for testing so I must learn how to do it and get the adequate amount of blood. I have another cat who had urinary tract problems last year and had to have what is called PU surgery where they enlarged the opening and essentially made him a female in that area. While that is not the problem, he picked up the MRSA (flesh eating disease) somewhere between the vet office here, the ER vet office here, or the vet specialist office in Jacksonville or the ER office there. I don't want to use the paw for BG testing since they share litter boxes. I don't know when the MRSA will be a problem again since I am not totally sure that the medicine we used took care of the problem or if it is just dormant for now. That is some nasty stuff that does not play fair at all. I will try to poke at an angle since I have not done that and do two pokes at once. I have poked once and tried to get enough blood then poked again when it was not enough. I bought some baby socks to put some rice in and will try that. Most of the time his ears are not that warm unless he has been in the sun.

I was talking ot the vet a while ago who thinks that maybe Bo only needs one injection per day. His BG at 10:00 was in the 300 hundreds and he will be tested again at 12:00. He will observe more today and then decide what the dosage will be. The ER vet gave him dextrose by IV during the night and he had no more seizures but I am sure that is in his system still.

I wonder if I need to give him a snack during the day in the event he has a drop. I am going to PetSmart to get some timer feeders and will see if that helps. I just don't know what to do on the days when I cannot be here with him.

Thanks to everyone in the forum. It is because of this group that I had already read about the hypo once he was diagnosed so I was somewhat prepared - at least with the Karo syrup and alternate food. I was not totally prepared for the scare that I had. The good thing is that we got through the episode and he was taken care of before I broke down. I had it together until I went to get him from the ER vet to take to his other vet. Without the instructions from this group, I may not have been prepared for this so I thank all of you so much for the information when I joined and for the information on this post. So great!
 
Cats metabolize insulin quickly and really need shots twice a day. It will be better to give a smaller dose twice a day than a larger dose once a day and have the shed depleated again by morning - it will be virtually impossible to regulate your kitty with once a day shots unfortunately.
 
I would keep an eye on him no matter what dose you decide to give since he had an apparent hypo and can be sensitive to insulin for a while.
 
just one quick thought. going to one shot a day will only mean that the cat hypos only once a day instead of twice and/or that the cat goes sky high again and becomes out of control in regards to BG numbers because of the unregulation and/or rebound it will cause. i don't wanna come across as dissing your vet but just want to explain that they just need to brush up on their diabetes skills. curving at the vet is unreliable information and increasing lantus doses in full unit increments based on that unreliable information is what causes situations like this. what needs to happen instead is the dose be reduced, and stick with twice a day shots while you continue to work on learning to hometest. has anyone checked to see if there's another member close enough to help you with learning to test? if not, i'd start there probably.
 
I've never used Lantus but a starting dose of 3 units on any cat no matter what the insulin is a high dose and you may already have gone past the dose he needs.
You may also do better using a lancing device than free hand. If you have one, spend some time clicking it around his face to get used to the click sound, let him smell it, talk to him and explain why you HAVE to test his ear. You were very lucky to have caught this and got him to ER. Hometesting is definitely needed and don't let him fool you with cries like you are hurting him. You're nervous, he picks up on it, you stick, he cries and it all goes down the drain. Be confident, know it has to be done, give a few treats, and lots and lots of praise AFTER you get the blood up and tested.
 
Maybe there is someone in your area that would willing to help?? There is a place on this site to find people that live in your area. Or just post here is you are not worried about posting it.
 
I'm some what of a newbie and I have to tell you.. I was scared and nervous to poke my cat's ear..but after watching the video and reliazing if I didn't do it my cat would be put down.. and so I became confident, I did test my other cats as well to get an idea on the numbers. I squated over my cat-petted him and talked to him. I had the supplies ready- cotton square so i don't poke my own finger, meter, lancet. In the beginning I used the lancet with the normal auto poke but now I just use the lancet since then I can line up the vein and slight poke gets me enough blood. Originally (when I was first doing this I had no idea)..so my Khan received a bit more bruising than we both wanted but now it is much more efficient. My cat -KHAN would be laying down paws out front with me squated over him-petting him, Use a flashlight to see where the vein is, I rubbed his ear gently to warm it up, place cotton pad on the back side of ear, then lined up lancet- at first I found the closer to the outside I went the better aim-it was later that I just went with using the lancet and not the auto poke (or whatever that is called) so I could get the vein on the first poke -later figured out a slight poke is all that is needed- so a deep poke would only hurt- once I saw a drop of blood -a slight squeeze to bring up more blood (just like a rn does to your finger when at the dr) so the drop of blood increases, slide the meter/meter strip up to drop of blood and the meter strip will wick the blood up. Then take cotton pad-dip in cold water-place on ear with slight pressure-pet cat, talk to cat, give cat food.. this is what works for me. Now my cat waits by his door way at the rt times for his poke, food then shot. I wait 15 mins -30mins before giving Humulin N.. but will soon be switching to Lantus-CAN't WAIT!! Good luck. Purrs, meows and cat support sent your way!
 
I don't mean to get at cross purposes with your vet, however...

With Lantus, I would not be inclinded to shoot one time per day. Remember, Lantus forms a "shed," unlike other insulins, and is designed to provide a 12-hour curve. The goal is to have good BG levels 24-hours a day. Shooting only one time a day means your cat will be on an insulin rollercoaster (for lack of a better term). If, for example, your vet decides 2 units a day is an appropriate dose, I'd want to shoot 1 unit BID, rather than one shot of 2 units. That way, you will be able to determine if 1 unit provides regulation for 12-hours. One shot of 2 units may provide regulation for 12-hours (or may bring on another hypo, if 2 units is too much in one shot), but what about hours 13 thru 23? The BG level is going to start to climb after 12-hours or so and what you will end up with is BG levels that hopefully are low (but not hypo) during the first part of the day, and BG levels that are high (hopefully not so high as to cause ketones or other problems with hyper's), during the last part of the day.

Since your cat just had a hypo, I can tell you this: If it were my cat, I'd take this opportunity to "reboot," and start with 1 unit BID, keep that does for several days, and hometest to see what the BG levels looked like. If it looks like 1 unit BID really isn't enough insulin for regulation, I'd increase the dose by a small amount ("small" being defined after I saw the BG levels at 1 unit BID), and stick with that "new" dose for at least several days, then review the situation again. What I wouldn't do is shoot one time a day, and I wouldn't increase the dose in 1 unit increments.
 
I may have misunderstood but you said you are using 31 gauge needles. Are you using needles to get a blood glucose sample or do you use lancets? If not, the 31 gauge lancet may be too small and a 29 gauge might make a better "hole". If you are using needles to get the sample, you should change to lancets.
 
Re: seizure tonight- DOSE SIZE

Remember, Bo is a VERY big cat and insulin dosage is based, on part, on the weight of the cat.
 
I do use lancets for the BG test, not needles. I have two different types. Someone had asked about the size of the needle for the shots since Bo was crying most of the time.

The vet does want me to try one shot a day 4 units and will retest Monday. I honestly don't know what to do. He has had several cats eventually get off the shots. And he really helped me with Andy who had the urinary tract issues. I think I will call him in the morning again to discuss. This is so hard.

I bought some timer feeders so i can have a snack for Bo during the day and maybe avoid hypo again. I hope that will help so that he does not go so long without some food. I think I read somewhere about 4 small meals a day...
 
Small meals during the day and night will help the pancreas to heal. Good idea. Not so good idea - one shot a day. Most cats metabolize insulin over a 12 hour period - starting with the shot, going to the nadir (lowest point in the cycle) and then heading back up to the 12th hour. There are variations on this theme - but not 24 hours. What will likely happen is that he will be in a decent place for the 12 hours after the shot, and then will be high for twelve hours. This creates a roller coaster that must feel pretty terrible.

But you can easily find out if this is right. Try it for a day and test at +16 and +20 and record the numbers. I would be amazed if he doesn't continue to rise from +12. Then you will have the data to give your vet.

As suggested, it is a much better idea to cut the dose in half and give it twice a day.
 
If you decide to give 4 units in one shot, PLEASE home test. I'd be concerned initially about a hypo - after all, he hypo'd at 4 units this time - and hyper for at least 12 hours. While hyper can bring about its own set of problems, hypo's call kill your cat.
 
fwiw, i wouldn't shoot 4 units again unless i was going to be around all day to take action if needed to save my cats life. especially right after one hypo on that dose. i've been doing this for 4 years now, advised hundreds and hundreds of people, read millions of words about feline diabetes, and learned from the best of the best diabetic feline owners and if there's one thing i have learned to never do it is to never shoot the same dose again that caused the hypo in the first place.
 
oh, no! most cats metabolize the insulin much quicker, so giving one shot means they'll be without insulin for a significant amount of time.

honestly, a vet who suggests one shot a day for a cat that is not nearing remission does not know the essentials about feline diabetes. mine did the same thing -- suggested i shoot cleo once a day (in his case, for a week) when she started insulin. as soon as i heard that i decided i'd be better off with advice from the lantus forum.


here's a great explanation of the need for twice daily dosing (marvistavet.com has great articles and videos on pet health, so it's a good site to keep bookmarked):
http://www.marvistavet.com/html/body_glargine_insulin.html

other relevant citations:

http://www.vetinfo.com/regulating-feline-diabetes-lantus.html

University of Queensland article: http://www.uq.edu.au/ccah/docs/diabetesinfo/link5.pdf:
"Better glycemic control is achieved with twice daily dosing rather than once daily"

http://www.uq.edu.au/ccah/index.html?page=43391&pid=0 on page 8: "Studies in healthy cats indicate twice daily dosing provides optimal glycemic control, and studies in diabetic cats also support twice daily use. ... This is also supported by the remission rates obtained in newly diagnosed cats."

The university of queensland article cited above supports twice daily dosing but it discussed the Rand protocol, which involves keeping cats in a clinic while they are on insulin at higher doses that may be unsafe at home. Jacquie Rand, the author, is now a supporter of the tilly protocol, a slightly modified version of which is followed at FDMB's lantus insulin support group, and is working on a study with the german katzen forum that came up with tilly. the german forum and our lantus group at fdmb have extremely encouraging remission rates for cats on lantus.


honestly, lantus works better if you build up to the proper dose in small increments. a large shot once a day into a cat will most likely mean a bigger drop in blood sugar, a bounce up from that drop as the body goes into self-protection mode, likelier hypo (extremely low blood sugar), then a period during which there's no more insulin left to keep blood sugar down. a bounce can mean higher numbers for multiple days.
you'll see here if you check our spreadsheets that even a late shot (at 14 hrs after the prior shot) can lead to higher numbers as the cat runs out of insulin/overlap between shots. shots every 24 hrs only will likely lead to uneven blood glucose control throughout the day, which can damage chances for remission/regulation for the cat.
 
Underdawg,

I'm a newbie here, but I just wanted to say congrats that you are even attempting to home test, it's a huge step in the right direction. I don't know what type of meter you are using, or if you can afford to buy a new one, but the ReliON micro from Wall Mart only needs 0.3uL (i'm a scientist and his is a seriously small volume) to do an accurate test. A couple of times I really thought I wasn't going to have enough, but just as the tiny drop was exhausted, the meter beeped telling me there was enough there. Meter 9USD 20ct strips another 9USD. Hope all goes well with your baby.

Tony and Buddy

PS. Just saw that you are using the AccuCheck Aviva. Very nice meter, very reputable, Roche is a top notch company we trust their products implicitly in the lab, 2X the sample size needed though. Just something to consider if you continue to have trouble getting enough blood. And no, I don't work for Wally World or ReliON, just really impressed with value/pricing/performance/ultra small sample size.
 
This morning I gave only 2 units. I had 4 units ready but shot out 2 of it because I just did not feel comfortable giving 4. I spoke with the vet who still thinks that one shot is fine and he is okay with my decision to give only 2 units. I will check BG more often now. I finally got it to work. I had to ditch the device and just use the lancet. Worked good after I got a coupld of pricks in. His BG was 131 11 hours after his shot this morning. I am glad I was not scheduled to give another shot this afternoon because I would not. So I think that I will be able to home test now without the lancet device by just using the lancet. I will keep a better eye on the BG and will try to test at the times someone suggested. Thanks for your help!!! I will read some of the information over and over so it will be easier to remember as I am trying to make decisions. I am feeling a lot better now! Bo certainly is too.
 
Fantastic that you are testing! Welcome to the Vampire Club -we'll give you the secret handshake later.....131 is a good number. We urge newbies not to give insulin under 200.

So the question is - how low did he go on 2 units? If he is 131 at +12, he could have been in the 50's or below at his nadir (lowest point in the cycle.) Are you going to experiment and wait till the am to give another shot? If so, our prediction will be that he is quite high in the morning. (If you have a chance, get a test tonight about +18 after the am shot and you will see what we mean. Insulin only lasts about 12 hours.) IMHO, 2 units is still too much. I would give one unit every 12 hours. That should even him out without real highs and lows.

Keep your data so you can show the vet exactly what is happening. We have this great template for a spreadsheet - color coded which makes it easy to see when they are too high or too low. http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=16
 
For sure, good decision to give only 2 units! From the looks of your spreadsheet (AWESOME that you are home testing!), if you got a low number 131 in the blues very late in the cycle, I bet you would have seen a much lower number near the mid point of today's cycle if you had tested then, so please don't go higher in the dose until you are able to be testing at least the pre-shots.

Very well done to drop down to the 2units! Whew.

Hopefully, with the practice, you will get better at the pokes and your being more at ease will spread to Bo and he will be more relaxed too. My two cats literally sleep through their ear pokes, so it will eventually become like breathing to you and also to Bo.

For now, the best BG numbers you really need to try and get are just before Bo's shots because you could find out that he's too low for a shot.

I wanted to mention one thing about feeding: try to remove food during the 2hrs before Bo's shots because food will artificially raise his numbers, then you'll give him his shot, the food will wear off, and down his numbers will come.
Then test before his shot, and if he is high enough for a shot, give him his shot and his food at the same time. If he tests low, then you need to wait and retest in say 15min to see if Bo's numbers are rising or not. Do not feed until you have decided if you are going to give him a shot or not. If in doubt, just post online here and people here can help you with the decision.

In a few more cycles on 2units, you will then see if that dose is OK or needs to be adjusted.
Forget about the one shot a day because it's not what works for cats. That is like putting 12hours worth of gas in your car, but have to drive for 24 hours .... you wanna push your car for 12 hours?
 
So great to hear that you were successful in hometesting!

Now that you are getting numbers at home, you no longer need to go into the vet for them to perform a glucose curve (yay! saves you money!). Instead, you can bring in a spreadsheet with your numbers or email it to your vet for him to take a look at and give advice.

I can't wait to see how your kitty will do on 2 units now! The goal will be to find a dose that will give you numbers that you can shoot twice a day so you can keep insulin in your kitty's system 24 hours a day instead of 12.
 
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