From
@Critter Mom
Members assisting Looby:
As you all may know, to date, Smiffy has been dosed 'blind'. With with the worry over the display of aggression - another potential hypo symptom - reported here a few weeks ago on one of Looby's earlier threads I would be concerned over the level of glycogen stored in Smiffy's liver at this time: if Smiffy has been fighting too high a dose for a period of time I would worry whether those levels may currently be depleted. (Note: The aggressive display was NOT at injection time.
(NB: This is a one-off contribution to the thread which I hope will be helpful to Looby and those seeking to assist her. I'm really ill and I can't run with this.)
Looby:
If I observed the clinical signs described above in my cat I would regard them as signs of a symptomatic hypo and I would have treated it as an emergency and therefore administered glucose or honey to quickly ramp BG back up to safe levels. Looby, you did exactly the right thing given your current situation; well done for acting promptly to help Smiffy. You also did well to get Smiffy to the vets straight away. Never let ANYONE try to tell you that you were wrong about that decision; it is a decision that further protected Smiffy.
In the absence of any other clear cut causal factor (e.g. a cardiovascular issue) if it were my cat I would want this incident to be handled "as if" it were a hypo.
1. You had a fructosamine test done but, as Sophie kindly pointed out before, it is
useless as a diagnostic aid when used standalone: in the absence of any home testing one MUST find some way to get a picture, however compromised by stress, etc., to gauge how low a dose may be taking a cat. Fructosamine tests have ZERO use in the determination of actual dose safety.
2. You have had your vet do previous spot check BG tests, the lower of which was in the 17 range - vet-influenced and with normal eating schedule. Today's vet-influenced reading of 13.4 is lower than the previous low of 17 BUT that was in an even more stressful scenario AND it was shortly after administration of what I assume probably was a reasonable amount of honey; with BOTH of those elevating factors in play and yet a lower BG level this is another strong argument in support of the position that Smiffy was dangerously low when she was bumping into things and drunk-walking and that therefore a dose reduction is necessary.
3. Another new variable is the recently-introduced Zylkene calming treatment. Firstly, if stress elevates blood glucose levels then it is reasonable to consider whether a calming treatment intended to reduce stress levels may also lower blood glucose levels. The active ingredient in Zylkene is casein which comes from whey. There is research which indicates that whey may lower blood glucose levels. (I would also wonder whether casein may have an impact on the normal counter-regulatory hormone cascade triggered when a cat is on too high a dose and needs protection from hypoglycaemia.) I recommend that you ask your vet to enquire with the manufacturer's technical department about the effect Zylkene may have on blood glucose levels. Until such time as this is known, if it were my cat I would stop giving the supplement as a safety precaution.
Looby - please can you clarify to the people helping you on this thread exactly what you mean by "whey food". Members need to understand what Smiffy is being fed in order to make sound suggestions to you.
4. I am relieved to hear that, at last, a vet run curve is booked. While not as reliable as data gathered in the normal environment (vet stress influence) when a cat is being dosed 'blind' (as has been the case for the last few weeks) a vet-run curve is better than no curve at all. Any dosing decision based on the curve should be highly conservative at this time and should allow for a nadir target set high enough to create some form of safety buffer to accommodate uncontrollable or unpredictable factors (e.g. Smiffy not eating enough at dose time or during the rest of the cycle).
If this were my cat I would insist on a dose reduction.
Going forward, either home testing needs to start NOW or else the vet needs to get much more involved with dose monitoring, if possible doing home visits to check BG - nadir being the most important value to obtain. At minimum Smiffy would need regular curves run at the vets if no home testing happens, especially if anything is introduced into Smiffy's regimen where its impact on blood glucose levels is an unknown.
Looby, to get helpful and safe input here you MUST be straight and realistic when reporting your cat's symptoms and status. I know it may be tempting to endeavour to soothe your own anxieties by trying to lessen the significance of Smiffy's worrying clinical signs and behaviours - and they
are worrying - but it is unfair to the people trying to help you if you fail to give them honest and accurate information. I am sorry if that sounds a bit harsh but I care about the needs and safety of advice givers as well as advice seekers and their cats. Clear, concise, and open communication helps keep everyone safe.
Mogs
EDITED TO ADD:
IMPORTANT NOTE: If Smiffy did have a symptomatic hypo yesterday then her body may become MORE SENSITIVE TO INSULIN as a consequence; another reason for a conservative approach to dosing going forward.
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