Testing Help & Asymptomatic Hypogycemia

Status
Not open for further replies.
S

Scratchy's Mom

Member
Those who have seen my prior post know that I can't seem to get my cat's ear to bleed. I'm able to warm the ear and lance it with the device, but no blood. I know I'm hitting the ear because I can see a mark afterward and can tell that he feels it. I live alone, so I only have 2 hands to work with. He can get free when I try to squeeze the ear for blood. Yesterday I took him for a fructosamine and they did a BG and it was 38. He had no symptoms of hypoglycemia which really scares me. They gave him glucose on the spot and he went up to 189 and they sent me to the 24 hour vet. 2 hours later he was down to 107. They had to admit him and I was presented with a $1,000 and $1,600 estimate for an overnight stay with tests every 2 hours. I nearly had a heart attack. They gave no insulin last night and he went up to 280. He's been taking 4 units of lantus twice a day. A lot, but lower doses seemed to have no effect. They are cutting the insulin in half and said we may be able to wean him off. He is now about 5 weeks on an almost entirely carb-free diet. The technician will work with me tonight to give me tips and tricks for testing. Its got to work because this cannot happen again. I don't want to lose him and I can't keep incurirng $1000 bills! Plus he won't eat at the vet.

Is it typical for a cat to experience such severe hypoglycemia and have no symptoms? This may have been going on for days. He was his usual self when I had to get him into the carrier. He was active, not overly hungry (although he did eat) and not at all wobbly. Because I've been unable to test, I've been relying on his symptoms to guide me. Hopefully the vet will be able to help tonight. I've tried different lancets, different lancing devices, the ear and the paw pad. I warm his ear with the rice sock and still nothing. The vet has had trouble getting blood too, although yesterday they couldn't get him to stop bleeding. They put some kind of powder on it and it stopped.
 
yes it is. my cat has read lo and I would never have known it if not for testing or him telling me.
have you tried the other ear. sometimes one ear bleeds better. also, what I do,is massage the ear first after I warm it or massage it enough to warm it and get blood flowing. sometimes I even let them shake their head and that pulls the blood up. if you are free handing the lancet. sometimes 2 pokes side by side rapidly works too.
can also try the paw but I have never done that
 
Glad to see you got your own thread! It sounds like you have had a terrible time.

Be patient with us. You may already be doing these things but we will try everything.

Here is a picture of the sweet spot: http://i106.photobucket.com/albums/m267 ... etspot.jpg You are aiming for the little capillaries that run off the main vein at the edge of the ear.

Do you have something behind the ear to poke against? We found having a small makeup sponge really helped.

If the problem is that he moves away before you have the chance to milk the ear, you could try the burrito. I put a towel down on the couch next to the arm. Then I plopped Oliver on top and wrapped him up so only his head was showing. I could gently press him into the arm so he couldn't get away while I poked and milked. Some people with really difficult cats try the clothespin trick: http://www.felinecrf.org/giving_sub-qs_ ... _peg_trick It mimics the momma cat holding the kitties by the scruff of the neck.

What size lancet? Usually the higher the lancet, the bigger the hole and the more blood. And at first, we double poked. Just a second quick poke in the same place.
 
I'll have to check the size of the lancet. I'm thinking its 28. I used a cottonball pressed up against the ear. One day there was actually blood on the cotton ball, indicating the poke went through but that was the end of the blood. I think I'm poking the right spot. He has very furry black ears so its hard to see, but I try to do it under a light bulb so I can see. I feel like I'm torturing him. I've been alternating ears and wraping him in a burrito with a blanket. Until the hypoglycemia, he was doing fine. He's the old Scratchy again like he was before he got sick. He's running again and jumping to high places. He's great for the shots. I hold up the syringe and he comes right over onto my lap and onto the arm of the couch where I give it to him. I couldn't ask for a better cat, just a better bleeder. He loves the carb-free food and doesn't eat more than a bite or two of dry food a day. Maybe two pokes in a row will work. I give him the treats even when I'm not successful since it was the same for him either way. I try to look at his hospitalization as a sign that he might be getting better. Would love to get him off insulin entirely, but half the dose is a good start.
 
Scratchy's Mom said:
Is it typical for a cat to experience such severe hypoglycemia and have no symptoms? This may have been going on for days. He was his usual self when I had to get him into the carrier. He was active, not overly hungry (although he did eat) and not at all wobbly. Because I've been unable to test, I've been relying on his symptoms to guide me.
Click to expand...

It can happen. My cat tested at 32 mg/dl a few hours after a PS of somewhere up in the 200s but he had no symtpom of hypo :shock: I only tested because I felt something was "off' even though my cat was acting just fine.
 
One more idea. If you put a dab of vaseline on the spot where you want to poke,sometimes that makes the blood bead up. And if you ever get blood and he starts to move, get it on your fingernail. You can test it there.
 
Before I found this board and learned some new methods, I shaved my cat's ear. He has very furry dark ears and so I could never see the blood. Just 2 or 3 strokes with a razor to thin the hair was all that I needed. I shaved, gave him treats, and let him go for a few hours.
 
One thing I've found that helped with one of my cats who is really stingy with her blood: First, I rub her ear and around her ear until it feels warm to me. Then I know there is enough blood in it that I have a chance. Then, I poke pretty close to the edge of the ear, on the outside of the ear but the edge toward the center of her head. Then I lightly press/pinch the ear just below where I've poked. This makes a "dam" in the vein, keeping the blood from flowing back to her head. (The blood goes up the outside, over the top, and down the inside, back to the head.) Usually if I just hold this for 10 seconds or so, a bead of blood will show up. Sometimes I also need to massage the edge of the ear closer to the top of the ear, so that the blood will flow down and out the hole.

I live alone, too, so it is a one-person task in my house. Megan also has black ears, but the inside of the ear flaps is very hairy, with long hairs, so the outside is a better bet even though it is black.

Once in a blue moon I'll hit a gusher, but that's rare with her. That happens much more often with her "brother" Darwin, who gets tested once every few weeks, even though he is a civvie. (He actually gets jealous of the attention she gets at testing time. I once decided to test him just to show him what was going on, and to my surprise he enjoyed the attention and wasn't bothered by the poke.)

Anyway, try the "dam" technique. It has really helped me get blood from a virtual turnip!
 
That dam idea makes sense. The tech at the vet showed me another interesting place to poke the ear toward the bottom on the inside which I may try. They also gave me 25 gauge lancets. Last night I had to take his bandages off his legs where they had the catheter and I thought he was going to kill me. He hated the bandages but hated me messing with them even more. I couldn't have gotten him to sit still for a test last night. In any event, he's been in a funk since he got back from the hospital and wasn't eating much last night, so I wasn't going to give him the shot anyway. I think it was the bandages that were bugging him because he ate as soon as I got them off, but by then it was too late for the shot.

Scratchy's fructosamine came back normal. The docs think he is going into remission. He's down from 4 to 2 units and may be reduced further this week. With any luck he'll be OTJ soon! Six weeks ago, he wasn't even regulated. I think the change in food really helped. He's gained back everything he lost plus an extra pound. I am keeping my fingers crossed and hoping to draw blood from somewhere tonight!
 
Squeak had a nearly normal fructosamine and we took him off of insulin but it turns out he still needed it a bit longer and that is when i finally learned to hometest. I'd be pretty leary though of giving 2 units at this point!
 
I am now even more baffled than before. I was able to test from paw pad last night and this morning. He didn't love it, but he didn't love the hospital stay or the ear prick either. I think if try the clothespins, he will never come near me again. Last night he was at 125. I called the vet and he said not to shoot if he is under 200. This morning was 133. No shot either last night or this morning. The vet who treated him Monday called me and said to keep giving him 2 units twice a day until his recheck on Sunday. He said I shouldn't keep testing. He also said the internist agreed. He said as long as Scratchy eats, I should give the shots because if I don't they won't be able to tell what is going on without consistency. He said I should just monitor him for clinical signs of hypoglycemia. The two problems with that are that I have to go to work after the shot (and to sleep at night) and that on Sunday he was at 38 with no clinical symptoms. Nor can I afford another $1,100 hospital stay. I don't think I like this plan. Am waiting for a call from my regular vet.
 
I am so glad you got blood and some numbers! And they are nice low numbers too!

You are getting really bad advice. You can't shoot at those numbers until you have some data. And the only way to get data is hometesting. Then you will be able to give him a dose appropriate for the number. (And 2 units is not appropriate for numbers in the 100)

The truth is they can't tell what is going on - only you can because you can test him in the home environment where he is not stressed out. They can bring him to the office, charge you a lot of money, test him all day while he is stressed out, and then have invalid information for you.

And the idea that you should just read up on hypos and wait for one is ridiculous. We are all about trying to avoid hypos, by careful testing and doses based on those numbers.

Have you ever given us your city and state? Would you like someone to give you a referral for an FD vet, if there is one near by? At least you could get a second opinion.
 
Ask your vet and the specialist if they would advocate this approach if you were talking about your child, or their child! This is absolutely the most ridiculous thing I've read in awhile... cat(2)_steam

Test. Do not shoot if under 200. Disregard your vet and find a new one.

SOrry. Those are my thoughts and obviously you have to do what you think is right.

But they need their heads examined.
 
This information is not coming from my regular vet. My vet is not 24 hours, so he had to be admitted to the 24 hour hospital so they could test every 2 hours and have glucose available if necessary. This is the vet who gave me this advice. He is very young, though I think I got better advice from his collegue last night who looks like he's 12 years old. He said test before each shot and don't give it if it is under 200. He said if it is 200-220 I can give it if I make sure he eats.

I am waiting for a call from Scratchy's regular doctor. Granted, Scratchy got 4 units when he had his 38 hypo on Sunday, but 2 still seems like a lot with those numbers. While he was staying at the vet he got up to 289, but that was after 20 hours of stress and a glucose drip the day before. I could even see if they said to use 1 unit. I know it might be hard to know what's going on if the treatment is inconsistent, but I'm not going to risk his life for an experiment.

He is also not eating as much since he got back. Maybe its because he's still in a bit of a funk, or maybe its because his blood suger isn't plummeting from insulin making him need to eat like a pig.
 
Is your question what dose to give if you get a 200'ish test result? Good question, and I'd suggest 1 unit max till you know more about how he responds to that dose...
 
Very few times will you hear me ever say you received bad vet advice...

this time is it.

Please keep testing.

If everything you say about the bandages, etc....your boy was totally stressed out and the numbers from the ER are no good.


An yes, they can be asymptomatic. Several cats on these boards are like that and if you were not home testing ....they'd seizure out before you knew what happened. Only home testing can prevent that.

Shave the ear sweet spot, use vaseline, warm and massage the ear....make it snuggle time... do whatever you need to do, but don't shoot him insulin unless you have a number.
 
Thank you all for verifying that I am not crazy. I know I am not a vet, but I am a responsible pet owner. I lucked out Sunday that he went in for a fructosamine test and they discovered the hypoglycemia. Testing the paw seems to be working. He doesn't love it, but the beef liver treats afterward help. It is a small price to pay for his continued health. He's at 133 at 24 hours after last insulin. I don't think giving 2 units and leaving the house is smart with that number. If it was 200, I'd be somewhat more comfortable. If it takes longer to see if he is in remission, so be it. At least he'll be alive! I imagine my regular vet will confirm that this was bad advice.
 
Great! It is always hard for someone new to feline diabetes to take the advice of strangers on the internet over a vet. In this case, I think you have truly saved Scratchy's life. I hope if your regular vet agrees, that he will say something to the other vet. Maybe you can save a few kitty's lives too - not everyone will take the time to read the information and check out the logic and go against vet advice.

Once you get some data, you can shoot a tiny dose of insulin at those lower numbers, and get him down in the double digits. No hurry - keep getting the numbers and be sure to record time and food given etc.

Can't remember - are you feeding several small meals a day? One of the signs that the pancreas is working is to test, feed and test 30 minutes or so after. If the pancreas is working, the number will go down after the food.
 
I generally leave food out. I am gone all day (often for a full 12 hours) and want to make sure he has access to food if his BG gets too low. But he does tend to eat a meal in the morning and again when I get home at night, so it is certainly doable. I don't really get why it wouldn't make sense to decrease the dose if they think he still needs insulin but has low numbers. We would increase when it was the other way around. The disagreement between the vet I spoke to last night is unsettling. There was more logic to the advice I got last night.
 
I'm not really sure what data I need to gather other than his BG, testing times and food intake. Is there something else? Right now a home curve is not realistic, partly beause I have to give insulin to do a curve. Also, my job makes it impossible for me to test every 2 hours, even on weekends. Also, he is not yet used to testing and tends to avoid me for a while afterward! I can test at peak time on the weekends if I give him the shot. In an ideal world I'd be home all the time to do everything right, but that's not my reality, which is also why I can't just follow the vet's advice and give him the 2 units no matter what and watch for symptoms of hypoglycemia.

I guess the bottom line is how do I gather data if his BG is too low to give him the shot.
 
You keep track of his numbers without insulin. Just like you do when you are giving insulin, note the time since the last shot. (So in your case, it will be +24 or something. If that becomes difficult, just one day since insulin, two days etc.) And note when he ate and what he ate. For now, in the am, in the pm and when you can, after he eats.

This will be great data for your vet to prove he is too low for 2 units. And it will help you see if food brings down his numbers on their own. And you will know if and when he gets high enough for a shot.

I would guess you may have to end up giving small doses of insulin at some point. I hope I am wrong and he just continues to come down on his own.
 
Thanks Just heard back from my regular vet. He agreed that I was given bad advice. He said no insulin if under 200. 1 unit if between 200 & 250, and 2 units if over 250 and certainly no insulin if he isn't eating. He definitely seemed to think Scratchy may be in remission and no longer insulin dependent. He told me to test at least once a day and monitor his symptoms (water intake, etc.). I will still keep a chart. Maybe he will end up at a lower dose, but I'd rather risk a temporary high BG than one too low.
 
One adjustment I would suggest. Rather than base the dose on the pre shot number (200 vs 250) I'd rather you get the nadir (lowest point in the cycle). If it is in the 40 -50 range, you reduce the dose. If it's the same, keep the dose. If it's high, increase by .5 units. That is just a general plan, but I hope you see the difference.

In general, insulin usually needs a couple days to settle before you change it also. PZI is better with changing doses, but not every shot.

If you increase by a whole unit rather than .5, you run the risk of going over the ideal dose.

Probably TMI since he isn't on insulin right now. A different way of looking at doses, which we have found successful.

Here is a more in depth explanation: http://binkyspage.tripod.com/SLGS.html
 
That all makes sense. Thank you for all your help. This message board is a godsend. We will see what the next few days bring. Hopefully more low numbers. My life has been dedicated to making him better for the past few months. I promised him I would help him feel better and I'm glad he does. The hypo set him back, but at least there is a good end result for now. I'm glad my regular vet agreed with the people on this board. He himself had a diabetic cat so he sees it from both sides.

I probably should also have mentioned that Scratchy is not my first diabetic cat. I was in law school when the other was diabetic so my parents were taking care of him. This was about 11 or 12 years ago. The vet had them urine testing. He went in and out of remission. He went outside and would sometimes get into fights which would trigger a recurrence. I'm pretty sure he died of hypoglycemia. My parents gave him the shot one night and found him in a coma the next morning. The vet had to put him down, but he was basically already gone. I don't want to lose another cat to this disease and I am determined not to!
 
Well. No blood since my last post. He has regained his strength and will not tolerate the paw poke or squeeze. I can poke his paw, but when I try to squeeze it, he makes awful noises and wriggles away. I still haven't been able to get any blood from his ear. I have not given insulin and have been monitoring his symptoms. He shows no signs of the diabetic symptoms he had before. He's active and he isn't drinking water or urinating more. If anything, it is less. Actually, both of my cats seem to be going less since I switched food. He is eating less than he was before the diabetes or with the insulin. Maybe his blood sugar had been plummeting after the shots causing him to eat a lot. Now it is normal. If I can't get any blood and all remains the same, I'll take him to the vet over the weekend, but that may produce abnormally high results.

I think I may need to find someone who lives in Los Angeles who can sit with my while I do it. At the vet, he is like a lump of clay. At home, he moves like a snake. I told him it would be over much faster if he just cooperated, but he didn't listen.
 
We have people in LA and I would strongly recommend getting some local help.

Meanwhile, can you test his urine for glucose?
 
Unlikely I can test his urine. I have two cats who share a box and I'm rarely home when he actually goes, which couldn't be more than twice a day. If I try to separate them, they will both go crazy. I've tried pretty much every suggestion I've gotten, so I'm either doing it wrong or I have a mutant cat with bloodless ears. I can get through the whole process, but can't get blood. He won't sit still for the paw. The people at the vet even have trouble with his ears. His ear is still healing from the last visit, because they had to go deeper than usual to get blood.

I think I need to start a thread looking for people in L.A.
 
I posted for you over in Community asking for LA help. You can also post a new topic here with LA in title. Do copy and paste in the URL from this post so they know a little bit about you.
 
Thank you for your help. I started a new topic here and gave a brief synopsis of the situation. I can't believe I'm unable to do this. I'm not even bothered by needles which is a good thing because I've had more luck drawing blood from myself during this process. I'm hopefully Scratchy will stay in remission, but I'd like to feel more confident about his treatment.
 
Hi, Scratchy's Mom!

I'm in northeastern Los Angeles, so if you're anywhere near, I'd be glad to come by and give you a few pointers and sit with you if you'd like. I can't do it until Thursday evening, though...school stuff. But Thursday - Sunday I can come by whenever you'd like.

PM me with your address, and let me know when would be good for you, if you want. If not, no issues...

Best-
Michele
 
Thank you so much! I am actually in Southwestern Los Angeles (in Mar Vista near Venice), so it might be a hike, though not as bad on the weekend. He is doing well and off the insulin so a few extra days shouldn't be a problem. I will let you know if I don't hear from someone closer by in the next day or two. Thanks again! I really appreciate it!

Janine
 
[ Testing the paw seems to be working. He doesn't love it, but the beef liver treats afterward help. It is a small price to pay for his continued health]

I test Cattro's paws as her ears don't seem to heal well. She is fine with her hind feet but not her front. I find warning her feet helps else I also have problems getting blood. I use a hot water bottle, not too hot, with a good cover, and I check to see that it's not dangerously hot, but she loves the hat and usually lies still once it's in place. his makes the process much easier.

Kay
 
He now hates having the paw done. I got hissed at twice trying tonight and had to let go. Maybe warming it will work. The problem isn't sticking him, its getting the blood out. He hates the squeezing. For some reason that seems to really freak him out.
 
Cattro also does't like the squeezing and I worry I will bruise her foot, so my pricking device has a see through top and when you press it back over the hole, it acts like a vacuum and the blood wells up pretty good - so I just hold it in place for a while, pressing gently to keep it over the hole and that works a treat most of the time.
 
Thank you. I will try that tonight. I also realized I need to clip some of the fur off his toes. He's long haired and has big tufts of fur between his toes which get in the way.
 
The advice I got on this board saved my cat's life. He started out with 3 units of Lantus twice a day then got 4 units twice a day and then promptly had a seizure without showing any symptoms whatsoever. His dose was changed to 4 units once a day after the seizure but i could not give him that much. I only gave 2. His numbers have been down so he has not had a shot in 4 weeks tomorrow. Since October 16, except for one 177 and the high numbers at the vet one day, his numbers have been less than 119 all the time and mostly less than 100. His lowest has been 50. His BG was 50 today at 11:30am after eating at 5 am this morning. Ear pricks got better once I got a Reli-On meter which needed only half the blood the AccuCheck Aviva did. My cat is a black and white tuxedo with black ears so it is very hard to see anyway. We use a head flashlight too so that both arms are availalble. I have to continuously distribute the chicken treats not only to the patient but also the other 3 that are watching the procedure and wanting treats. This new meter only needs a speck of blood and sometimes i can hardly even see it. We have to rub ears for a few minutes prior to testing and sometimes even change ears in the process. The vaseline does help too.

All good advice on this board. Sounds like you did get some really bad advice from that vet!
 
And after the seizure, I also got timer feeders so that he could have some food during the day when I was gone. I got up at night to give him another small meal. I think having 4 small meals in a 24 hour period helped him get off the insulin too. He is back on 2 meals a day with chicken treats sometime during the day and while testing once a day now that he is not getting a shot. He wonders where the midnight snack is though.
 
I always left food around in case his blood sugar went down. He is eating quite a bit less since he's been off insulin, which indicates to me that his BG may have been too low for a while. I am very lucky I was taking him to the vet that day. Your situation seems very similar to mine. Black and white cat with black ears going from 4 units twice a day to none. I have the AlphaTrak meter for animals which needs only a speck of blood. Now if I could only get that speck! I have the same issue with the treats too, only this cat will really get in the way if the treats are out before the test is done. He is the worst when it comes to stealing food. I've never given him any of my food while I'm eating, but he still persists in trying to steal it. He'll steal Scratchy's treats if Scratchy doesn't inhale them quickly. He acts like a dog.

That vet called me the other day to see how Scratchy was. I told him my regular vet said not to give him insulin and that I listened to him. Sometimes you just can't listen to everything your vet tells you to do.
 
So true! I was not giving shots but still checking BG. I sent BG levels to my vet and he would "adjust" the insulin (even though I was not giving it!) when he would see the numbers. You can see his adjustments on Bo's SS and can see that I am not giving shots. I also talked to another vet as a consultation. She did not like the large starting dose that we used and she LIKES home testing and says I should go by those numbers. The other vet said that my meter had different readings than his tests (i took my meter at the time of the curve) so my meter read 60 -70 points lower than his. But the new vet also compared my meter with her test of one of her hospital cats that lives in the office. Her meter was 10 points higher than mine. Does the regular vet need some calibration on his machine? So I will go by my meter. Someone on this board said that their vet said that "blood was blood" and everyone who responded to my posts said that they use the readings from their meter and make no adjustments like my vet wanted me to do.

Honestly the best thing that I did was get the Reli-on meter which requires so little blood it is hard to see AND to get the freeze-dried chicken to use all during the process of me trying to get the ear pricked. My husband thought of the flashlight that you wear on your head so once we did all those things, the ear pricks actually got better. I still do not have many times of only needing one prick but I am down to 3-4 instead of 10 or so. I know Bo likes that better but as long as the chicken keeps coming, he is fine. AND the GREAT news is that he has not had a shot in 4 weeks as of tomorrow! He was only diagonosed the end of SEptember and he is OTJ! I think the other great advice I got here was to put him on the high protein canned food (not dry). so the change in diet and giving 4 small meals a day while he was on insulin changed his need for insulin. I think all that combined has meant success for him with low numbers. Now I hope we can maintain! Good luck!
 
I think the dietary change helped Scratchy too. Before he was eating wet and dry about 50/50, but even the wet was high in carbs. Now he eats EVO 95% meat mostly wet with maybe a few bites of dry per day. He started insulin in August. He did drink some water last night, but nothing excessive and nothing in the litter box like I was seeing before. He's unfortunately getting worse with the testing. He just won't sit still for 2 seconds. I can't even touch his paws anymore despite the treats. I wish I had enough hands to test while giving him (and his brother) treats. I have to get his BG done at the vet which I'm sure will be higher than it would be at home.
 
Got Scratchy to the vet yesterday and his BG was 96 with no insulin for 10 days! My vet was very pleased. Glad I didn't listen to the vet who told me to keep giving him insulin.
 
Status
Not open for further replies.
Back
Top