Shadow 3 hypo crashes, 490 AMPS, not eating

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ShadowsCaretaker

Member Since 2013
Current needs/help: dosage suggestion, PM shot or not (has not been getting 2 shots a day since crashes, and trouble feeding...ate a bit yesterday, but not since 6pm and now won't eat. Considering some syringe feeding soon. We've thrown everything and the kitchen sink in front of him: 3 types canned, ham, turkey, tuna, (he does do tuna juice/blended gravy, but not today), parmesian topped, poached talipia, Fancy Feast (this is all we could get him to eat besides Gerber 2nd Foods yesterday, but he won't eat it now.

Shadow is on Prozinc, prior to Hypo crash was on 2.8u (40u scale). We use 100u syringes. He has had 3 hypo crashes in 4 days during vet and overnight e.r. Was on no insulin for 1.5 days, then given 1.2u, crashed 5.5 hrs. later, no insulin for a day, then 2.8u and hypo crash after 7.5 hrs. Then no insulin for 48 hrs. and on 5/11/13 was given AM shot of .4u, no evening shot, then .8u on 5/12/13 with AMPS BG of 491 - Shadow also has IBD and was previously eating Friskies Kibble (oh now that I know better I'll get him on Wellness ASAP when he's stable). Not an issue now since he won't eat at all and not kibble either.

Has barely eaten the past few days, unfortunately vet wasn't even feeding except AM so as to not mess-up BG monitoriing...but, Shadow is a Freefeeder and usually nibbles every 20 min. throughout the day.

Sorry for format, pasted from my SS, will try to get and use your groups spreadsheet.

Date Time BG Insulin (100u) Insulin (40u) Food Log & Notes
5/10/13 9:00 AM 340 0 0 Exact time & number unknown, basic recall from vet
5/10/13 12:00 PM 340 0 0 Exact time & number unknown, basic recall from vet
5/10/13 2:45 PM 337 0 0 About 1/4 can at vet
5/10/13 7:18 PM 312 0 0 Did not eat at home at all
5/10/13 10:50 PM 275 0 0 Nan fed at 2:30am and licked maybe 1/2tsp Wells RD
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5/11/13 8:30 AM 380 1 0.4 Insulin given at 9:30am - Drank water several times before noon
5/11/13 11:30 AM 375 0 Had force fed several chunks tuna 30 min. prior to test
5/11/13 1:45 PM 199 0 12:45pm drank blended tuna water
0 2:00pm ate 2 tsp. gerber 2nd foods chicken noodle baby food, drank fair amt blended tuna gravy
0 2:15pm 1/4 tab Pepcid AC
5/11/13 3:50 PM 147 0 5hrs.20min. After insulin...3:55pm ate 1 Tblsp. Fancy Fiest…gobbled it down, wouldn't eat baby food after, but then did fair amount of tuna gravy
5/11/13 4:56 PM 145 0
5/11/13 5:56 PM 153 0 After BG ate 1 tsp. fancy feast and licked tuna gravy
5/11/13 8:30 PM 251 0 Legs wobbly when walks, but can walk. Did jump onto windowsill. Will not eat, tried fancy fiest first, then baby food, then tuna gravy
0 Called Dr. Weisbrode (female @ e.r. vet) at 9:00pm. Said, we did everything right and wobbly legs just weak and OK for now. Told us based on 251 and how he's been crashing to not give PM insulin.

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5/12/13 8:50 AM 490 0 Gave Pepcid AC, didn't eat overnight except lots of tuna water, but not stirred so wasn't gravy. Drank a few licks of water when he got up, walked to table, no poop
5/12/13 10:20 AM 2 0.8 Gave insulin. Tried to get dosing advice from e.r. but couldn't
5/12/13 12:30 PM 358 0
5/12/13 2:24 AM 256 0 didn't know so close to testing time, 10 min. prior force fed 2 small bites fancy feast, 2 small syringes baby food. Felt the need since no food at all in 18hrs.

Does anyone know how fast those bits of food & baby food syringes may kick in and how many BG points such a small amount would have 10 min. prior to testing?

Should Nadir/peak should be at 4:00pm

I will continue posting/updating his numbers ( just edited post and put on last reading). I appreciate any/all help and suggestions. He is VERY sensitive to insulin right now after 3 hypo crashes in 4 days and so we are going very very low compared to normal management figures. For example, yesterday's .4 (40u) dose (1u on 100u syringe) and today due to 490 AMPS I did increase minimally another .4...still scared that may be too much for our rebounding, bouncy, multi-hypo-crashin complicated case.

Thank you all in advance,
Matt
 
You might want to post a 911 in the main health topic board. I put up a request to get some eyes over here, but that board has the most heavy traffic.

How long has your cat been on insulin? What is his regular diet?
 
Here are some tips to get him to eat. I have asked an experienced PZI user to have a look but personally given his hypos and that he isnt eating I would keep the dose really low for now - and only give it if he is over 200 preshot.


Cheryl & Winnie wrote:
Enticing a Cat to Eat

Here are some things you can do do entice your cat to eat:

-sometimes in order to get a cat to eat you even have to resort to dry it is more important that they eat. there are a couple low carb / grain free brands -- EVO and wellness core.

-making a buffet to give him choices
- heating food

sprinkle food with :
FortiFlora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
parmesean cheese
smashed crumbles of dry food
bonito/tuna flakes (Can be found at Asian markets or sometimes in the Asian food section of a large grocery store.)
halo chicken treats (freeze dried chicken) -- crumble into dust over food -- my Wolfie loves this stuff.
pour a little water from tuna in water over food (I use low sodium/no sodium added as other kinds in water has veg. broth in it and I assume that means onions, which are toxic to cats and it shouldn't contain soy -- check labels)
powdered oregano. yep sounds weird . but some cats like it and it will entice them to eat.

other ideas of foods to offer your kitty to stim appy:
trader joe tuna for cats
baby food -- beechnut or Gerber Stage 2 -- you want a baby food that is only a protein + broth (although the Gerber contains cornstarch). It should have no onions or other additives. some babyfoods have onions . please read labels if you can't find beechnut.
kentucky fried chicken
deli turkey /chicken
plain cooked ( boiled or baked ) chicken breast
canned chicken for people (watch the label that their are no onions)
chicken broth -- low sodium

If enticements don't work, you should consider:
-assist feeding ( syringe or make little meatballs and place in mouth)
-and/or talking to your vet about appetite stimulents ( mirtazapine or cyproheptidine)
Click to expand...
 
It is most important he eat. I would try baby food - beechnut meat is good - a brand with no spices. Yes, you can syringe food. Here is some info:

Getting your cat to eat
Assisted feeding Assisted feeding

Syringe feeding

The best way to know what is going on is to test midcycle. His pmps numbers are fairly low and yes, he may be going too low midcycle. So then, reduce the dose by .25 or .5

You are using U100 needles. Are you using U40 ProZinc? Are you using the conversion chart?

Get him eating. Then we can help with the dose. Has your vet thought about pancreatitis? Here is some info. See if any of the symptoms fit:

http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=83108

It can cause loss of appetite big time.
 
Mary & Simba said:
You might want to post a 911 in the main health topic board. I put up a request to get some eyes over here, but that board has the most heavy traffic.

How long has your cat been on insulin? What is his regular diet?
Click to expand...

Thank you for your reply and request on main board you made. Got one more reply besides yours, so maybe it's helping. Shadow has been on insulin 4 years. He has been on the same dosage for about 2.5 yrs. I can remember some fructosamine tests, but unsure how long ago. His regular diet has been Friskies Seafood Sensations dry kibble. He grazes about every 30 min. throughout the day. (the past few days I've been reading up on low carb/food and will get him on canned Wellness, etc. when he's over this). He has been given Hills, JD as treats after injections (about 2 Tbsp), but mixed with a sprinkle of some other powdered med for his diaharea/IBD/low absorption. Sometimes he doesn't eat it all and usually after a few days won't eat it, we stop offering for a few days and then he will. Shadow is underweight...about 9lbs and has struggled with that the past year. At this point he looks anorexic. Unfortunately we had him vaccinated last summer and he was the supposed 1 in 1,000 that had a reaction to it and was in hospital for days...never again!
 
Sue and Oliver (GA) said:
It is most important he eat. I would try baby food - beechnut meat is good - a brand with no spices. Yes, you can syringe food. Here is some info:

Getting your cat to eat
Assisted feeding Assisted feeding

Syringe feeding

The best way to know what is going on is to test midcycle. His pmps numbers are fairly low and yes, he may be going too low midcycle. So then, reduce the dose by .25 or .5

You are using U100 needles. Are you using U40 ProZinc? Are you using the conversion chart?

Get him eating. Then we can help with the dose. Has your vet thought about pancreatitis? Here is some info. See if any of the symptoms fit:

http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=83108

It can cause loss of appetite big time.
Click to expand...

---------------------------
Thank you. Yes, we use U40 ProZinc and U100 needles. Yes, I am using 2.5 conversion. In my spreadsheet/numbers in my post I have it listed as U100 first and also the convert U40 number second for people who may not be used to the U100 scale.

Pancreatitis: No, my vet did not mention it. He did mention possible (highly rare) pancreatic tumor. I personally however encountered a great article on EPI exocrine pancreatic insufficiency and I will talk to the Vet tomorrow about testing for both of those and see what is going on with his Pancreas...I think that's the issue with his weight, diarrhea and loss of appetite.
 
The other thing you need to do is tesT for ketones. A cat who is not eating, in high numbers can develop DKA which can be deadly. Do you have ketone strips and can you get a test?
 
Sue and Oliver (GA) said:
The best way to know what is going on is to test midcycle. His pmps numbers are fairly low and yes, he may be going too low midcycle. So then, reduce the dose by .25 or .5
Click to expand...

Forgot to mention that his pmps test last night (251) was at only 11hrs. from shot (AMPS was at 8:30am, but didn't shoot until 9:30am because I had to talk to the Vet on the phone first).
 
Sue and Oliver (GA) said:
The other thing you need to do is tesT for ketones. A cat who is not eating, in high numbers can develop DKA which can be deadly. Do you have ketone strips and can you get a test?
Click to expand...

Thank you Sue and Oliver: I'm aware of DKA. I do not have strips. At this point I think he only peed once last evening and it is unlikely I can get a test. I know the Vet did blood work last week and I can't recall, but maybe just trace ketones, but that would have been just after his first hypo crash. Since he spent several days with NO insulin in the aftermath, and now 3 days with only 1 dose...plus the low food intake...I think I'll have blood work done at the Vet tomorrow for ketones as well as see what they can test for Pancreatitis or exocrine pancreatic insufficiency (EPI), and if so get him on pancreatic enzyme supplements.
 
I'd watch him very carefully tonight and consider the ER vet if you see any signs of dehydration (pull his skin up - does it spring back?) or confusion or if he suddenly seems very weak or disoriented. I am concerned a vet visit tomorrow may be late.
 
Shadow BG summary and update:

5/12/13 8:50 AM 490 AMPS
5/12/13 10:20 AM Shot .8u (40U) scale - 2u on 100U scale)
5/12/13 12:30 PM 358 +2 hrs
5/12/13 2:24 AM 256 +4 hrs
5/12/13 3:30 PM 207 +5 hrs

Yesterday's lows were 147 at +5.5hrs. 145 at +6.5hrs. (back up to 153 at +7.5) ....so I expect nadir/low today to be at 5:00pm...another 1.5hrs from now. The past 3 hrs. he's basically steadily dropping 50 pts. per hour. Hopefully at that pace he'll bottom out at 132 today...I'm feeling pretty good except him not eating and going to have to syringe feed and hit the Vet tomorrow for blood tests for ketones and pancreas stuff...maybe iv if electrolystes and other stuff depleted.
 
Part of the bg level is the absence of food. No food = lower levels. I sure hope you can syringe some food in before you think about a dose tonight.
 
Dehydration tests:

1) Gently pull up the fur scruff of the neck and release. If it stays pulled up (aka tented), that is moderate to severe dehydration.

2) Lift the lip and press firmly on the gums, then release. If it stays blanched instead of almost immediately pinking back up, there is mild dehydration present. The longer it stays blanched, the more dehydrated.

If he is not in diabetic ketoacidosis, and only needs subcutaneous fluids, those may be done at home. Some cats can be a bit squirmy doing this and may need to be burrito-wrapped for restraint.
 
Sue and Oliver (GA) said:
I'd watch him very carefully tonight and consider the ER vet if you see any signs of dehydration (pull his skin up - does it spring back?) or confusion or if he suddenly seems very weak or disoriented. I am concerned a vet visit tomorrow may be late.
Click to expand...
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Thank you for this comment and to all who have replied!

We took Shadow to the E.R. Vet this evening at 5:00 PM. Unfortunately, they were very busy and the total check-in time was 3 hrs....2.5 hrs. before I got to talk to the Vet. After returning for the estimate and bringing back his Insulin (they didn't have U40), his tuna gravy, and fancy feast (they do have baby food there) they hadn't yet done simply blood test to see what to put in the I.V. but he was next in line for blood test. Unfortunately due to previous I.V.'s we have only one leg left that is viable, and they may have to do the I.V. in his jugular (ouch, +$100 more).

Tonight he will be getting I.V., appetite stimulant medicine, offered food every two hrs. and hopefully will eat. We discussed syringe feeding in the early AM if he won't eat. I will talk to vet prior to his 10:30pm insulin to see how he's doing and agree upon dosage...I'm going to insist on syringe feeding if he's still not eating by 1:00am since besides the I.V. I'm basically paying them $450 to feed him tonight. He will be transferred to primary Vet. in the AM (for free since they have another transfer patient). I hope they get the I.V. in the front leg and that he eats tonight.

Update on his BG numbers for anyone interested on how that went and anyone searching forum for things like: insulin dosage after hypoglycemia / hypoglycemic ... here's the last parts of his day:

4:30 PM +6 hrs. (low point/nadir) BG of 198
6:30 PM +8 hrs. BG of 229

While he didn't go as low as optimal, I'm glad I erred on the side of caution because of his wild rebounds and 3 hypo crashes. I don't think he'd survive another one.

He will be getting insulin tonight (his first PM / double dose in like 4 days). I have given range numbers for dosage to Vet. and she is to call me prior to injection to discuss/agree.

I'll keep you all updated on our little fighter Shadow...and maybe find out how to post a picture of him tomorrow. He's a handsome Siamese looking fellow and more "human" than cat...especially compared to our other cat Snowball (his all white, blue-eyed sister). We named him Shadow because he literally follows us all around. He basically lives on my 80 yr. old mother's lap! Shadow is 10 yrs. old by the way.

Thanks again to all...and the comment I quoted above makes me feel better about our decision to take him to E.R. this evening. Thanks Sue/Oliver!
 
I am glad he is in the ER. They should be able to tube feed him too if syringe is not enough. Be thinking about you and your sweet guy tonight. Hope everthing goes well.
 
Wendy&Tiggy said:
baby food -- beechnut or Gerber Stage 2 -- you want a baby food that is only a protein + broth (although the Gerber contains cornstarch). It should have no onions or other additives. some babyfoods have onions . please read labels if you can't find beechnut.
appetite stimulants ( mirtazapine or cyproheptidine)
Click to expand...
[/quote]

Thank you so much for this post. Even though we had Gerber 2nd foods as recommended (online suggestion)...they were chicken noodle and turkey/rice and both had onion powder in them!!!! We since got the Beechnut you recommended!

I called the E.R. vet after discovering this. They said the small amount in the small portion he ate was not an issue...something about over a larger period of time and red blood cells, or if it had been whole onions would have been serious. However, I find it odd that he had just started to eat yesterday, baby food first, then Fancy Feast...and then after that stopped eating...perhaps the onion powder was part of it? At any rate he's at E.R. now per last posting and we got rid of the bad baby food.

Also, at the E.R. tonight he's getting some appetite stimulant meds...don't know which one...but if they work I'll report back which one they gave him.
 
Thank you all for the well wishes. Shadow is amongst the living. Unfortunately, even after an I.V. and 2mg. Cyproheptadine appetite stimulant last night he still wouldn't eat. They force fed him 2 times, about a tsp. each time of canned food, and supposed to get one more in him prior to transfer to regular vet that just happened. Blood tests last night indicated possible kidney problems, but it may have been elevated due to dehydration. We will likely have him re-tested for that today and then perhaps pancreitis? He will be able to get more appetite stimulant at about 11:00am today, perhaps that will do the trick. No insulin last night and BG is doing well.
 
You scared me! We usually use a candle to indicate a kitty has died. Glad Shadow did okay last night and will be getting more attention this am. If food is the main issue, have they considered a feeding tube? It sounds awful but can be very successful and can be done at home by the owner.

http://catinfo.org/?link=feedingtubes
 
Sue and Oliver (GA) said:
You scared me! We usually use a candle to indicate a kitty has died. Glad Shadow did okay last night and will be getting more attention this am. If food is the main issue, have they considered a feeding tube? It sounds awful but can be very successful and can be done at home by the owner.

http://catinfo.org/?link=feedingtubes
Click to expand...

Oh my goodness I'm so sorry about misusing the candle (new here). I thought it meant to light a candle/pray, I guess maybe that's the smaller candle on the tray?

At any rate, things do not look good at all. No, food is not the problem at this point. Blood test last night and again this morning are pointing to serious kidney problems...very low in 2 of 3 items, red cell count way down to 18...so he's not in regeneration mode. Numbers down/worse than last night and previous tests last week...so dehydration was not the issue since I.V. all night didn't improve those numbers. Prognosis not good at all.

We went to the vet and 5 types of food, and he had has another appetite stimulant about an hour prior. The only thing he willingly did was lap up some raw scrambled egg. We ended up force feeding about 1 tsp Fancy Feast and about 8 mL syringe fed baby food...so thats a good amount. We will return in another 2 hrs. to do again. We are planning a subcutaneous liquid prior to bringing him home for the night at 5:30...think he's better off here than E.R. We'll keep trying to feed him, and tomorrow AM go back to vet for I.V. and if by afternoon he's still heading downhill we will likely bring him home for lots of loving for as long as he holds out and isn't suffering...then put him down :( There's some hope/small chance his kidneys pick up and get flushed from the I.V. and he pulls through this...but not looking very good at this point.
 
I am really sorry to hear this. The link I gave you about feeding is part of this site:

http://www.felinecrf.org It's an excellent resource and may help you understand this whole thing better.


Paws and fingers crossed that things will go well and he'll start to perk up. (One thing that sometimes makes them feel better is to take an unwashed shirt of yours to the vet for them to lie on. The smell is comforting.
 
Keeping you and Shadow close in my thoughts & prayers. The candle frightened me... good wishes through the night.
 
Shadow update: He's doing OK, but not great. We picked him up from the vet at 5:30 tonight after visiting twice today and having to force feed him. The only thing he would do willingly was raw scrambled eggs (wouldn't even eat the cooked ones...nor his usual favorite of tuna water/gravy).

Unfortunately as soon as we got in the car and were leaving parking lot he vomited. Perhaps we over-fed him at 3:30 (about 2 small balls of fancy feast and 15mL syringe fed baby food...not all of which went down). After allowing him a nap and forgoing any feeding for a while due to vomiting, at about 8:00 he didn't seem well at all. His tongue was hanging out a bit, and also insides of eyelids coming in...we thought he was dying and brought him to my mom's lap and stroked him, talked to him, loved him, and said our thanks for the wonderful 10 yrs. we have enjoyed him and said our goodbyes. I did a couple 3 mL's of molasses even though his BG was fine (like 166 at nadir), took his BG and temperature (since he'd been at a cold 97 all day at the vet despite hot blower in the morning and heating pad all day). When we got him home we put him on heating pad (heater in truck on way home), and when he moved off of it made him lie in the sun...he moved to the cool tile floor after a while...at any rate his armpit temp was actually 99 and late 100...so that was good.

So, after the lap time and supposed goodbyes and molasses, he surprised us and jumped down, walked 20 ft. to the litter box in the garage, jumped in the big box and urinated. After he was done though he just sat down and I had to retrieve him. After some chill time just sitting around after that, some more stroking and leaving him be at times, we did 10mL syringe feeding baby food at 9:30 (we had given him 1/4 pill Pepcid AC at 8:00). He's now sleeping with him mommy, gave him appetite stimulant at 10:00 and will do BG at 11:00pm (had his AM insulin @ 10:45 today), then feed, then determine if any insulin needed and then probably leave him be for 3 hrs.

So, he's hanging in there for now...tired, but able to walk, resting comfortably...VERY GLAD TO BE HOME IN BED WITH HIS MOMMY (instead of E.R.). His BG was fine today (AMPS 402 and gave .4U (40U scale) insulin, but interestingly best guess at Nadir was 175 at +5.25 hrs. And simultaneous at +8.75hrs was 166 (simultaneous to giving the molasses. So I guess he must have had Nadir maybe an hr. later at maybe 160?) Which is kinda amazing from 402 to 160 on only .4U...of course he's not eaten well and is off of 3 Hypo crashes and not doing well.

Thanks to all for your support and counsel....I'll keep you posted. If he makes it thru the night we will go to vet at 8:00am to go back on I.V., re-test for kidney numbers tomorrow and take it from there.
 
Shadow Short Update: Great News from today's blood work! Amazingly, after 2 days of bad numbers (and declining) on his Kidney related blood work, today's numbers improved in all 3 categories!!!! One is now even on the "low part of normal". Additionally, his red blood cells showed some imrprovement from the very low yesterday of 18 up to 23 today. His alertness is a bit better today (at vet) the two times we have visited to feed him. So, we thought if kidney numbers were worse today we might have to put him down, but now seems he is improving slightly and we and the vet aren't giving up on him yet. We will bring him home again tonight :)

Last night was a hard/long ordeal of feedings every 2-2.5 hrs. (forced syringe baby food...basically all chicken). Today we have done two feeding and switched over to puree of Hill's AD and JD 50/50 with water. I know Hill's isn't the best in general, but right now he needs the other nutrients and more importantly he needs the carbohydrates because proteins are very hard on the kidneys.

His BG's were fine last night but took a bizarre turn this morning that has both the vet. and I totally confounded.

11:45 PMPS 371 dosage .4 u (40U scale)
+5 hrs. 334
+8.5 hrs. 183
+10.5 hrs. 231
+12.5 hrs. 172 (dropping with NO insulin given??? whaaa???

Has anyone ever had any experience with dropping BG's while being fed, and at 10+ hrs. with NO insulin???

Retesting BG at vet at 4:00pm and picking up from vet a bit after 5

He also had no bowel movements for many days. But Saturday evening he had a weird 2 inch long very firm stool. Weird because he has had chronic diarrhea for 2 yrs. Then early AM overnight he did a 4 inch one that was similar. Really good was that at the vet today he took a bit smaller than normal, but fairly normal BM that the vet said was "normal/healthy" consistency/color (not another hard log...not diarrhea). So perhaps his intestines have cleared out/detoxed from friskies kibble (since he's not eaten kibble in 8 days) and he's moved out some constipation problem.

Thanks again to all for the help and support...any tips on Kidney support?

I'll update again.
 
Sending healing vines and feel better vines and eat more vines to Shadow. It's really hard to deal with all those kidney issues on top of the diabetes.

Nice to read that he was coming home tonight. Hope he feels and acts better at home where I know he gets lots and lots of love.
 
Thanks again for the well wishes. We have had several people praying hard for Shadow, a visitor/friend of his last night and another tonight. He is getting tons of love and support! Shadow is doing very well tonight!!! He's less blurry eyed and more focused than last night, and was at vet today during feedings. His weird drop in BG with no glucose has thankfully reversed and our little shooting star is back.

We switched from baby food to blended Hills & water and it's so much easier to syringe feed. He has been drinking it right down and licking his chops...much better than baby food.

From the weird low/dropping BG (with no insulin AM) of 172 at noon,
Up to 289 at 4:00pm
291 at 8:30pm (interesting how level it stayed here over 4.5 hrs.)
356 at 10:00pm (just tested)

I am about to re-test and shoot at 10:30 to get him back a bit earlier than the late 11:45 shot last night, I'm going to give him a bit lower dose since even .8U last night made him too low for the AM shot and therefore can hopefully get AM shot and back on twice a day to stabalize and even things out BG and dosage wise over the next days. At 380+ he can certainly take .4U as last time tha tput him at 167 nadir, but with the way he didn't rebound today I'm going to maybe do slightly less in hopes of an AM shot and also less risk of hypo and easier to sleep without worry of that for me. On my 100U syringe the .4U is 1U, so I'm going to go for .75U on my syringe I think.

Well wishes for all of your pets. Goodnight.
 
It is great to hear that Shadow is feeling better and more interested in eating. His insulin levels are probably pretty unpredictable at this point. On a good day with a "normal" healthy cat on insulin, things like the neighbor 's dog barking or a visit with small children or a slight tummyache can change the bg levels,so who knows how all this turmoil is affecting Shadow. As long as his levels are safe, I wouldn't put much stock in what they are doing. Once you get past this crisis, then you can try to get him stablized in terms of blood glucose levlels and doses.

Continued hopes for good days and steady progress.
 
Sue and Oliver (GA) said:
It is great to hear that Shadow is feeling better and more interested in eating. His insulin levels are probably pretty unpredictable at this point. On a good day with a "normal" healthy cat on insulin, things like the neighbor 's dog barking or a visit with small children or a slight tummyache can change the bg levels,so who knows how all this turmoil is affecting Shadow. As long as his levels are safe, I wouldn't put much stock in what they are doing. Once you get past this crisis, then you can try to get him stablized in terms of blood glucose levlels and doses.

Continued hopes for good days and steady progress.
Click to expand...

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Grreat comment Sue and Oliver...right on the money! Two days prior to his hypo crash we babysat a 5 yr. old for 6 hrs...crying at first. He sometimes hides with strange visitors and kids. Probably stressed him and also reduced access to his food. Also the next day we had a damn Kirby vaccum demo for 2 hrs. He hates the vacccum and hid under the bed. More stress and reduced food access. I think at that point he stopped eating and crashed the next morning around 11:00 am.
 
Amazing great news on Shadow!!! After 3.5 days of force feeding, he actually ate on his own at the vet today!!! Only about a tsp. but it is such a great turning point to see the appetite come back and to know he ate by himself! We did give him 1/2 the amount via syringe about 40 min. after that tsp. as he wouldn't eat more. But we are now going to try going off the syringe so that he can get and stay hungry enough to eat on his own. After no appetite stimulant yesterday or last night. He had one this morning at 7:45 before going into the vet.

The other, and maybe most important news is his blood tests today! For the second day in a row he had improvement in all the Kidney numbers! One is still below normal but climbing. One had gotten just into the low part of normal yesterday and now moved up higher into normal range. The third has always been normal, but is the least important of the 3. His red blood cells had a very tiny upward increase from like 23.2 to 23.9...but two days ago it was down to 18...so all is very very good.

He is much more alert and looks the best he has in 4 days. We are sooo relieved and feel he is really going to pull through this!

Many thanks to all for your encouragement, positive thoughts and prayers!
 
Shadow continues to do well. He ate again at the vet today two more times. That's 3 total. Unfortunately he hasn't eaten since 2:30pm or so and now it's 7:15. He ate about 3tsp total today at vet, but was syringe fed 10mL at 7:30am prior to going in.

He was given the appetite stimulant 45 mins. prior to last try at feeding and no luck.

His BG was a weird again today...dropping even after +12hrs. and we weren't able to do the AM dose again..dang it. He started zooming back up this afternoon:

4:00pm 380
6:10pm 458 - PM shot given here, early - did slightly less than .4U (40U scale)

Hoping that maybe now with the early and very small shot we can finally get an AM shot in.

The other good news for him is I'm going to call in his BG in the morning and the vet thinks he can stay home tomorrow if he eats well and stays hydrated. His potassium has been low and added to I.V., but we got an oral potassium gel, so with a good night he will stay home tomorrow and not need the I.V.!

We will likely take him in Fri. AM for blood test to see if his kidney number continue to improve, check for hydration, electrolytes and potassium...that way if he need I.V. on Friday he can get it before going into the weekend (our pet hospital/vet clinic close on weekends) and start off good into the weekend.

He still seems MUCH more alert and willing to walk around a bit...not so lethargic.

It seems like I notice his appetite is less when his BG is high. Can anyone confirm this? Do cats eath more with low BG and less when it's high (or stop)??
 
This is encouraging news!

All I am aware of is if cats dip low, they eat to bring their blood glucose numbers back up. We see it all the time during hypos. It seems to be a reflex.
 
Possible explanations:

With a high glucose, the cat may feel unwell and thus be less interested in food. If high long enough ketones may develop, a serious complication of diabetes.

With lower glucose, he may actually be hungry, especially if he is more active.
 
BJM said:
Possible explanations:

With a high glucose, the cat may feel unwell and thus be less interested in food. If high long enough.com ketones may develop, a serious complication of diabetes.

With lower glucose, he may actually be hungry, especially if he is more active.
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Thank you. That's both what I have observed and what makes sense logically. I just tried to feed him and he's still not interested. But, I'm thinking his BG is just starting to drop now at +3 hrs. and going to try again in an hour. I'm well aware of Ketones and he hasn't gotten that high, nor shown any signs of them.
 
Also, correlation is not causation. Something else could be causing the lack of interest in food and possibly causing the high numbers.

Common co-conditions in diabetes include:
- pancreatitis where the pancreas is inflamed and painful,
- hepatic lipidosis where fat breakdown is overtaxing the liver (look for yellowing of the whites of the eyes and of the skin, and vomiting),
- inflammatory bowel disease (sometimes due to food intolerance)

If you observe 'meatloafing', where the cat hunches in a crouched position, that can be a sign the cat doesn't feel well. In my signature link Secondary Monitoring Tools, there are some other ways to assess your cat, including the 5 Ps, and monitoring food and water intake.

Your qualitative assessment is just as important as numbers, too. "Just ain't doing right" is a clue, even when its hard to pin down why you think that.
 
ShadowsCaretaker said:
BJM said:
Possible explanations:

With a high glucose, the cat may feel unwell and thus be less interested in food. If high long enough.com ketones may develop, a serious complication of diabetes.

With lower glucose, he may actually be hungry, especially if he is more active.
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---------------------------
Thank you. That's both what I have observed and what makes sense logically. I just tried to feed him and he's still not interested. But, I'm thinking his BG is just starting to drop now at +3 hrs. and going to try again in an hour. I'm well aware of Ketones and he hasn't gotten that high, nor shown any signs of them.
Click to expand...

Ketones can happen at low numbers, so don't be lulled into thinking you don't need to test for ketones.
Some cats are just prone to ketones, no matter how their numbers may be; others just don't seem to get them.
Be sure to use KETOSTIX to check urine and be sure no ketones show up.
 
As ketones are a by-product of fat breakdown, they will happen anytime that fat is being broken down - body fat, food fat, it doesn't matter. Thats why we're more concerned when it goes blatantly high - its more likely you are heading into diabetic ketoacidosis.
 
BJM said:
Also, correlation is not causation. Something else could be causing the lack of interest in food and possibly causing the high numbers.

Common co-conditions in diabetes include:
- pancreatitis where the pancreas is inflamed and painful,
- hepatic lipidosis where fat breakdown is overtaxing the liver (look for yellowing of the whites of the eyes and of the skin, and vomiting),
- inflammatory bowel disease (sometimes due to food intolerance)

If you observe 'meatloafing', where the cat hunches in a crouched position, that can be a sign the cat doesn't feel well. In my signature link Secondary Monitoring Tools, there are some other ways to assess your cat, including the 5 Ps, and monitoring food and water intake.

Your qualitative assessment is just as important as numbers, too. "Just ain't doing right" is a clue, even when its hard to pin down why you think that.
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BJM, Thank you for the helpful and informative response! I will research your links. Yes, Shadow does have IBD! Also, with 3 hypo crashes (two that were very advanced), it's clear that all of his organs took a hit. Kidneys bigtime and I'm sure his pancreas and liver aren't doing well either. He's on a good, slow mend though :) The vet thinks kidneys are the primary issue at the moment and also that gives major symptomw loss of appetite.

He has been doing the meatloaf pretty much for a week. Yes, after three bad hypocrashes he hasn't yet "looked well"...although with IV, syringed, eating on his own, and time he has gotten the sparkle back in his eyes, will look around and follow us with his eyes and I know his potassium was way low and related to that foggy vs. alert type behavior.

-Last night he had stopped eating and after 8 hrs. we syringed the rest of the night
-This morning he ate again about 1 spoon (before appetite stimulant)
-He ate again about 3 hrs. later - another spoonful (about 4 hrs. after stimulant)
-An our later he licked some food
-He has not eaten since. (at least he did resume some eating)
-At this point he hasn't eaten in 6 hrs. and the vet said after 8 hrs. to syringe

He got to stay home from the vet today and they removed his I.V. before he came home last night. We got a tube of Potassium gel from the vet and have been giving every 12 hrs. We also got some "Smart water" which also has potassium and electrolytes. He is drinking fine. Altogether that should do about the same as the I.V.

AMBG was 296 and that was at +14 hrs.
+15 hrs. 232 (weird to drop with no insulin, but he's been doing this 2 days)
+16 hrs. AMPS 308 - shot was maybe .25U (40U scale) - about .8U (100U scale) because we really want to get him on 2 shots a day and are struggling with that since he is doing this weird dropping at +15 hrs. and stuff that prevents the second shot.

+6hrs. 283 (3 hrs. basically no food)
+8hrs. 281 (5 hrs. no food)

On a positive note his bowel movements have improved and he had a "perfect" one this afternoon! This is an IBD cat that has had diarrhea for 2 years, despite being on Metranizadol (or however you spell/say it). The past few days we have seen the first formed logs in years! Colors have changed too, and he started out after not pooping for days with a very long, hard, dark brown (with some grey parts). I think he was contipated, reacting to the change from Friskies to canned Hills (detox) and may have sloughed some of that protective mucus membrane that protects people and cats from toxic foods. (it was not an intentional switch...he won't eat kibble now...and he was a kibble addicts with occasional canned food treats (Hills's) offered after shots as a reward. But, after a few days he gets sick of it (in the past) and I wonder if it's not the same thing going on now...he gets tired of the canned, but he won't do kibble now. BTW, bought some Wellness kibble and canned.

We will take him to vet tomorrow. Get blood test for electrolytes, potassium, and make sure he doesn't need I.V. before the weekend. Also will test for kidney levels and hopefully he will show a third testing of improved kidney function.

Thanks,
Matt, Nan, and Shadow
 
I'm happy to report that Shadow seems to be doing very well.
- He did eat on his own 3 times, but only abut 1 spoon twice and 1/2 spoon the other
- He has been drinking, peeing and pooping very well
- With all that, plus Smart Water (electrolytes & potassium), and Potassium gel
he is going to stay home today!
His PMPS 342 - gave .4U shot
+6hrs 221
+12hrs 188 (not AM shot)
+13.25 hrs. 157 - ate 1/2 spoon of food

Due to 3 days of weird dropping after +12, and irregular feeding, I AM CHANGING MY TACTIC. I will now just wait until he is 350-360 and give him .4U (BG level and dosage that worked perfectly overnight). Until his eating stabilizes I thinks it's futile to try to get him on 12hr. dosage schedule and keep messing with dosage levels, That can wait.

So, he gets 3 more days and night at home (plus yesterday and last night), vet on Monday morning for blood work. Other than that, if I don't update/post here then no news is good news.

I don't know if I mentioned this, but we started him on a cat GNC multi-vitamin from Petsmart yesterday afternoon. It's a gel so it should be easy on the stomach, and as per "yummy" advertisement...he actually will lick it right from the tube! This morning I mixed 1/2 inch of it with 1 spoon of food to encourage him an make the food even yummier!

Thanks again,
Shadow, Matt and Mommy/Nan
 
I really like how you are adapting to his needs and finding new ways to help. I hope you all have a lovely weekend and that he decides he is really hungry.
 
Sue and Oliver (GA) said:
I really like how you are adapting to his needs and finding new ways to help. I hope you all have a lovely weekend and that he decides he is really hungry.
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Thank you so much Sue and Oliver. GREAT NEWS!!!! Shadow had turned a very important corner!!!! This afternoon I put him on the back of the couch (where he usually likes to hang out a lot) and he stayed there 2 hrs. Then he got down, went to his food dish, and ate about 6 kibbled dry food (new Wellness food with a few Friskies mixed in) and ate about 6 kibbles! This is the first time in 11 days he has eaten kibble (I know dry is not the best, but he has been 90% dry free feeder previously). Then he jumped up into my mom's recliner...it did take him 2 tries to make it, but he got up there to cuddle on her lap. This is also the first time he had jumped into a lap in 11 days. About 20 min. later he was offered and ate some canned Wells/Wellness 75%/25% mix. Back to lap. Another hour later he did the same, but like 8 kibbles, then canned. So he ate 4 times in 5 hrs!!!! Instead of the one time in 5-7 hrs. and was acting like a more "normal cat"!!! His eyes are bright, he is walking much better and faster pace, he peed, and has the most energy I've seen!

I think it's time, Smart water, Vitamins (I think that was key, even though vet wasn't to keen on them...when I researched vitamins for liver, kidneys, and pancreas I found the GNC cat gel multi-vitamin had like 10 of 11 of the things mentioned! And also the potassium gel the vet gave us was a huge benefit for home care.

The other key thing I did was what I last indicated: I disregarded the 12hr. dosing timing crap...and instead waited until he hit 357 and did .8U as worked perfect before! So, no AM dose at 10:15am, but when he hit the number at 1:15 this afternoon I gave the shot. The key was adjusting the TIMING of the shot, keeping the dosage to what I knew it would do...because his eating was too random and throwing everything off in terms of BG. I will continue with this for a week or so. Basically the past few days it shapes up like this: He needs .8U every 15 hrs. He can't do one every 12 hrs. and skipping a shot and waiting 24 was sending him too high and bouncing him around!

We are sooooo relieved and happy!!!!! For sure he has turned a major corner and we now are assured he is going to LIVE! Also what is wonderful is that in this process he has naturally migrated to canned food, and now mixing in Wellness as well (because he LOVED the gravy of the tuna flavored Wellness...though wouldn't eat the chunks). So Hill AD and Wellness (the last time I mashed chunks and mixed more in) is doing the trick. Basically the bonus is that he is simultaneously transitioning to both canned and Wellness during all this. As a side note/benefit, our other cat "Snowball", his sister, is getting transitioned to the Wellness kibble and canned as well...she like canned and eating Wellness kibble with a bit of Friskies kibble mixed in. In a week or so, both our cats will be on Wellness canned food, 3 times daily, and Wellness kibble available inbetween and for teeth cleaning!!!!

I think Shadow, at such low dosage as we have him on (from him previous 3U twice daily, down to .8U / 15hrs., combined with diet change may actually cure his IBD AND may actually get him off the insulin juice after 4 years!!!

:) Matt

PS I've posted long extensive accounts on his case so that perhaps others in the future can find things here by searching the forum. That's what I did when I got here and case histories and dosage was great input. I intend to write up a special paper to post here and also to distribute to local vets and the internet about "AFTERCARE FOLLOWING A HYPOGLYCEMIC EPISODE / CRASH". Our vets unfortunately totally screwed it up and crashed him into hypo 2 more times after the initial incident. If Shadow had died I would have not only blamed them, I would have sued them for $5,000 in small claims court. I want other cats to benefit from what I have learned...to have them live and thrive and not have to suffer like poor Shadow, or worse yet, to die due to ill-informed vets and inadequate protocols and lack of home testing...home testing was key...our dang vets never mentioned it in 4 years since diagnosis...fricking ridiculous!!!
 
As promised, uploade Avatar for Shadow and attaching larger picture here. This is him just now taken...on his couch and feeling much better! He looks a lot like a Siamese, with white stockings, grey body and black towards ends of limbs before going to white. White belly. His white half nose "star"/streak and then full white chin make him one very handsome boy kitty! He has brilliant blue eyes that look right into your soul as he stares intently at people. His sister Snowball is pure white with stunning blue eyes (literally blood brother/sister). Fortunately Snowball has always been in perfect health and goes from nicely fit to about 2 lbs heavy during winter. I have pics of them napping together, literally hugging with their arms interlocked that will make you just go "Awww, that's sooo dang cute!"

I wish everyone and their cats a great, healthy weekend...lots of love to all.
 

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What a beautiful boy and what good news. It is great he is interested in food again - a giant step. I think all your efforts to get him back after the reoccuring hypos would be a value to others. The Think Tank might be a good place for a thread?

Yes, we call it "chasing the number". Sometimes with kitties that are going OTJ and need insulin, but less than 12/12, the owner waits till the number is in their preset range and then shoots a tiny amount, usually on a longer time frame than the regular 12 hours.
 
Beautiful picture. I'd love to see the one with the two cats snuggling that you mentioned.

Glad to hear the appetite has improved.
A combination of better food and home testing to know what is going on with the insulin seems to have made major improvements in Shadow. Keep it up Shadow! :RAHCAT :RAHCAT :RAHCAT
 
Thank you for the last three comments, compliments on handsome Shadow, congrats on eating and your encouraging words for my care. As to writing a paper and posting it to that forum, interestingly I was already thinking of that idea and now you have given me the right place to post it. Thank you. I will also be taking printed copies to my Vet for their review and to give to any new patients following a Hypo event!

SHADOW UPDATE 10:30PM, SAT. MAY 18TH: I am so happy to report that Shadow has continued to eat! Basically every 2-3 hrs. He starts with a bit of Wellness kibble, at which point I know he is hungry and follow with canned food (at this point a combination of Hills and Wellnes). I have discovered an important SECRET TO FEEDING A CAT THAT WON"T EAT...or eat much: After he eats 3/4 to 1 spoon of canned food and has stopped eating and even after some very light, slow petting that usually encourages him to eat, I found that I can offer a different flavor (switching from Hills AD, RD, and JD and also with various Wellness flavors mixed), then he will eat another 3/4 to 1 spoonful!! I have thus been able to double his food intake whereas I would previously thought he was "full" or "done" and given up!

A "magic moment" happened this afternoon I just have to share with you all (and see following picture capturing it). Snowball his sister was napping on mommy's bed and he jumped up on the bed and had lay down a few feet away from her. She has very interestingly been very stand-offish of him since he has been sick. She usually sleeps on mommy's bed with him and her, but lately won't sleep with them, nor has she gone near him and has been staying clear (probably she knows he is sick and doesn't want to "catch it"). I fed Shadow on the bed as he lay 2 feet from his sleeping sister. When I got done I scratched his chin and gave him kudos for eating (2 full spoons-fulls...the most yet!). Then he got up, walked over to his sleeping sister and plopped down beside her. He then kissed her and licked her face once or twice. She woke up and began to lick his face back and groom him! They laid beside each other and cuddled up together to take a long 2 hr. nap together!!! What a special moment! It's like the photo I said I had that was so cute...when I saw it, I grabbed my cell and snapped a shot that captures the moment that she has accepted Shadow back as "healthy" and "OK" to be around. Tonight he has been eating regularly, took a good pee, a nice 2 inch BM, his BG is down to a nice 182 at +7.5hrs. He has been out in the living room with the family and spent several hours on mommy's recliner cuddled up on the footstool next to his sister :) We are beside ourselves with joy and relief!

Thank you all for your great support, comments, and assistance. This forum and the links/support from posters has been invaluable in his care!

And so, without further adieu...here is the picture of Shadow reunited with his sister Snowball as they cuddle and nap! How cute is this???? PS: Snowball says she's not really as fat as she looks in this pic...it really is the camera angle! She's about 12 lbs.


Good night and thoughts to you all and your kitties!
Matt, Nan, Shadow and Snowball
 

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Thank you for sharing the cat snuggling picture.

Here is hoping for continued improvement in Shadow and more kitty snuggles.
 
Deb & Wink said:
Thank you for sharing the cat snuggling picture.

Here is hoping for continued improvement in Shadow and more kitty snuggles.
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Congrats on your OTJ in 5 months! I wish I had known then what I know now...or that my Vet had told us about home testing, proper diet, etc. Shadow is now ON The Juice for 4 years now! Unfortunately I hear the longer they are on it, the less chance of OTJ!

We are already slowly changing to Wellness food and of course are now on board with home testing. Will will try to work with Tight Regulation and perhaps he still has a chance at OTJ!

At 4:45AMPS he was 330 and we shot him with .4 and at +7 hrs. (because he has been on 14 hr. cycle) he was an AMAZING BG of 116!!! This is the first time below 150, much less to hit the 100-120 "normal cat level". He did so much better today and stayed below 200 for like 9 hrs! He was ready for a shot at 5:00pm and was at 373...gave .4U Right now I'm trying to shoot him with a consistent dose of .4U when he hits 330 or above...regardless of 12 hrs - 15 hrs, etc.

Shadow continue to eat every 2-3 hrs., drink, regular urination, bowels, and we are continuing with GNC Multivitamin, Potassium Gel every 12 hrs. He is snacking on about a dozen kibbles when he gets hungry (which we take as a sign) and when done we then offer canned food...which each eat 1-2 spoons.

Back to Vet tomorrow for blood work and I really think his kidney numbers will be much improved. He is jumping up/down from the bed, walking to litter box, walking out to eat at food dish all on his own!
 
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