SMOKEY'S SECOND HYPOGLYCEMIC INCIDENT

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Lorna&Smokey

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Hi All,

I need a new vet, near Kingsway & Boundary in Vancouver, who has experience with diabetic cats, and charges a reasonable fee. Can anyone make a recommendation? As well, I need to learn how to take Smokey's blood.

HISTORY: Smokey is around 10 years old; he has been with me since May, 2002. He was found on the streets of Vancouver, BC in a very emaciated state. Within a few months he became very sick and was treated for severe anemia and was later diagnosed with asthma. His health has been a rough road but he has such a strong will to live and is very patient when I try to help him. He regularly takes prednisilone (not prednisone) and terbutaline. On October 6, 2010 he was diagnosed with diabetes with a blood glucose of 20 mmol/L.

On October 6th his BG was 20. He was put on Caninsulin 2U x2/day.
On October 16th his BG was 12 so Caninsulin was increased to 3U x2/day.
On October 26th his BG was 1.9 so Caninsulin was decreased to 2U x2/day.
On October 30th his BG was 4.9 so Caninsulin was continued at 2U x2/day.
On November 6th, I came home to find him in a hypoglycemic state close to coma. It was so frightening! He was rigid but still conscious. I gave corn syrup and he came around within minutes.

So we started again...
On November 9th his BG was "Hi" so Caninsulin was started again at 2U x2/day.
On November 13th his BG was 20 so Caninsulin was increased to 3U x2/day.
On November 18th his BG was 2.8 so Caninsulin was decreased to 2U x2/day.
On November 29th he had another hypoglycemic incident while I was away and his catsitter was with him. She took him to the vet for IV glucose. He came home the next day with instructions to give him no insulin and bring him back in one week for a BG. I came home December 3rd and starting giving him Caninsulin 2U x2/day.

DOES ANYONE HAVE AN EXPLANATION??

I bought a Lifescan OneTouch Ultra glucometer with Delica lancets. The box says they are the thinnest lancet from OneTouch. A friend who previously had a diabetic cat and took blood came to teach me but we couldn't get any blood from his ear. What lancets should I buy and where can I get them?

Smokey and I would appreciate any help.

Cheers,
Lorna & Smokey
 
Re: SMOKEY'S SECOND NEAR COMA - HELP!!

I am not sure what you mean by coma. But maybe we can answer some of the questions. Have you read the warnings on Catinsulin (called Vetsulin in the US?) viewtopic.php?f=19&t=311 That may be why you are having such variable readings.

The best thing we can probably do for you right now is to help you get a test at home.

You might try a larger lancet - like a 25 or 26 gauge. Also, you can double poke - make a larger hole by poking twice quickly in the same spot.

Have you warmed his ear? Put raw rice in a thinnish sock, knot and warm until very warm but not hot in the microwave. Hold next to the ear for 30-40 seconds.

Are you poking in the right spot? Where to poke Put a flashlight up to the ear so you can see the large vein running down it. You are aiming for the capillaries that run off it to the edge.
 
Re: SMOKEY'S SECOND NEAR COMA - HELP!!

There are a few tricks to help you get blood from the ears. One is to warm the ear with a warm rice sock or wash cloth. Just make sure it is warm to your touch but not hot. Hold it against the ear to help warm it up and also support it while you poke. Another trick is to massage the ear before and immediately after you poke to get the blood flowing.

Ears learn to bleed. You will find that once you have taken a few readings, getting blood will be easier.

You need to test before every shot. If your reading is 200 mg or less, then do not give insulin. I believe this converts to 11.1 mmol and anything below this number is in your don't shoot range.

You may want to also ask your vet about changing insulins. First, because of the warnings about Caninsulin. Second, because it is a shorter acting insulin, it also has steep drops in the BG levels. Some better choices are Lantus, Levemir, PZI and ProZinc. These are longer acting insulins and cats respond well to them. I also suggest you start back at 1 unit twice a day. Most likely you have missed your optimal dose. Most cats are on 1 or 2 units and if they are on 2 units, gradually have been raised to that dose.
 
Re: SMOKEY'S SECOND NEAR COMA - HELP!!

Generally you want to raise the dose in smaller increments, no more than 1/2 unit change at a time. If you can get the home testing working that is your best tool to get the dose right. You especially want to know what the BG is before each shot (as others said if it is already running lowish, shooting on that is dangerous), and you want what the lowest # in the cycle is.

When we were on Vetsulin (Caninsulin), Bix's nadir (lowest point in the shot cycle, when the insulin is at it's peak), was about 4.5 hours after a shot. You can have a 400 before the shot time and a 20 nadir (if the dose is too high), so it makes a huge difference when evaluating the BGs to know at what point in the cycle the test was taken.

There can also be an effect if they don't eat the same amount every day. A safe dose one day can be dangerous another day if they aren't eating.

If he hypo'd on 2u I would reduce the dose until you have mastered testing and can evaluate what is going on. At the same time you want to be testing his urine for ketones. You can get Ketostix at most drugstores (ask at the Pharmacy if you don't see it with the diabetic supplies) for around $12 I think, and Walmart has a version of them that is under $5.

Good job catching & treating the hypos. That has got to be terrifying. :YMHUG: There is lots of knowledge and experience on the board, so keep asking whatever questions you have!
 
Re: SMOKEY'S SECOND NEAR COMA - HELP!!

Dear Lorna, and, of course you too, sweet Smokey,

You asked for an explanation...

Can you tell us what he's eating -- and particularly if his diet has changed since he's been getting insulin?

It might be a clue...

I like it that he has a strong will to live! Apparently, so do you, dear Lorna...

In the meantime, please consider a lower dose until you figure things out kind of hugs,
Deb and Nikki -- and Giz...
 
Re: SMOKEY'S SECOND NEAR COMA - HELP!!

I can probably help you with the testing. I've sent you a private message - you'll see at the top of the page where it says if you have any messages (when you are signed in).
 
SMOKEY'S SECOND NEAR COMA - HELP!!

Thanks to everyone for the replies; I don't feel so alone anymore. I feel better knowing there is help out there. Smokey will soon be appreciating all the help too. He is such a lovely cat.

By near coma, I mean he was still conscious because he cried so helplessly but couldn't move and was stretched out on his side on the cold tile. I found him when I came home so missed all the stages. He had passed urine and feces both times on the floor beside him.

I just read about Caninsulin; that could be the problem. Giving 2U in a 40 U syringe may be another factor as it is difficult to to be accurate.

He is fed Purina dietetic management (DM) canned food. Sometimes I mix it with Fancy Feast turkey and giblets if he is fussy. He also gets raw or cooked beef.

I agree that one of my first steps is to learn to take blood from him. It shouldn't be too difficult for me as I am a lab tech and have taken lots of blood from humans but it's different with Smokey! The "vein" I see in his ear is near the edge and is so small, about the size of a thread! Tomorrow, I will make phone calls to find a vet close to where I now live. I'll ask if they have experience with diabetic cats and if they can teach me to take Smokey's blood. I'd like to try him on a different insulin as well. In the meantime, I'll keep him on 1U x2/day.

Hugs,
Lorna
 
Most definitely switching to a better and longer lasting insulin is a great idea.
Caninsulin may be OK for dogs, but not for cats. I first started Shadoe on Caninsulin but quickly switched to Lantus, and when she was dx with acromegaly, I switched to Levemir as it's much more gentle at high doses.
I really wonder why vets are still saying to use Caninsulin/Vetsulin
Lawsuit against Vetsulin Manufacturer
Vetsulin FDAs Warning December 15, 2009

I would not worry too much about finding a vet that knows alot about FD, but rather look for a vet who is good in a variety of areas on treatments and is willing to work with you.
 
Re: SMOKEY'S SECOND NEAR COMA - HELP!!

Lorna&Smokey said:
Giving 2U in a 40 U syringe may be another factor as it is difficult to to be accurate.
Click to expand...

I'm not really sure what you mean by this statement.

2 units of U40 insulin in U40 syringes should be easy to measure.

The first mark closest to the needle is 'zero', then the next little marks are 1,2. Then 3,4,5 (first numbered mark).

There should be about 1/4" of insulin in the tip of the syringe...that would be 2 units of U40 insulin in a U40 syringe.
 
Hi All,
Yesterday, I could only think "What am I going to do?" Now I have someone from FDMG coming to teach me how to take blood on Tuesday. I'll keep everyone updated.
Lorna
 
Hi there... I'm in Vancouver (downtown) and would be happy to help you hometest and give you a bit of support locally should you need or want it. I've just returned home after a day out but will read this thread thoroughly tomorrow morning. Please send a pm to me if you want me to give you a call. I'm off work tomorrow.

Best of luck.
 
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