Very High BG, vomiting

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Cathy Palmer

Cathy Palmer

Member Since 2015
I awoke to find that my kitty, Zachary, is feeling very badly and "dry heaving." I just took his BG and it's 562 (it's been in the 300's, lately) and it has never been that high before. I think this was because he had his insulin before bed but it looks like he lost his entire dinner during the night. Not sure of the best thing to do, this morning, I fed him his usual breakfast and wanted to increase his insulin (1 unit since his hypoglycemic episode a day or so after Christmas) but I'm afraid that he will vomit again and then the insulin increase will be way too much. After the hypoglycemic episode I have been erring on the side of too high but this is way too high. I'm thinking that I should watch him carefully all day and try to get another BG mid day. If he vomits give him maybe 1/2 his usual food, with no insulin. Maybe at his bedtime meal if his BG is still really high I should increase to 1.5 and make sure his food stays down. Am I on the right track? Any insight?
 
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I agree with Tammy. If there is no improvement very soon then I think your kitty needs to see a vet.

How is Zachary's appetite?
Is he wanting to eat but then subsequently throwing up?
Does he appear nauseous? (Lip licking/smacking; looking like he wants to eat but then walks away?)

Could he be constipated? Is he prone to furballs?

Does Zachary have any history of ketones?
Do you have ketone test strips that you can test his pee with?
Does his breath smell like normal kitty breath, or fruity like acetone?

Sending well-wishes to your kitty, and a big hug to you.

Eliz
 
NB: Please can you post which insulin you are using.


It might be a stomach upset, but I think you should get Zachary seen by a vet. If Zachary were mine:

1. I would not increase his insulin dose. You need to get professional advice about a safe, effective dose for Zachary because without enough insulin there is a greater risk of Zachary developing ketones (and possibly DKA).

2. I would call my vet straight away (out of hours or emergency service if necessary) and arrange to have Zachary seen as soon as possible. Cats need to eat very regularly, and even more so if they are receiving insulin.

3. I would test for ketones ASAP. Have you any ketone urine test strips at home? If you don't have ketone test strips at home, bring a urine sample with you and ask your vet to test for ketones. (If you get anything more than TRACE ketones as a test result you need to get Zachary to a vet straight away. He will require treatment by a vet as a matter of urgency.

4. I would try to feed Zachary small amounts with a little water mixed in to help with hydration. (Check his gums to see if they're sticky-feeling - good test for hydration.) Any food you can get into him is good. If you need to, give him a different food if he'll eat it (even if the carbs aren't ideal).

5. I would monitor blood glucose levels in the meantime (in case the food he brought up left him without enough carbs).

If your vet is doing blood tests ask if he can do a SNAP fPL at the practice - it can give you a yes/no for pancreatitis. He can then send off a sample for a Spec fPL (tests severity) if the SNAP is positive.

There is no way of determining the precise cause of the elevated BG. (Could be the GI upset, could be infection, could be something else entirely. You need to see the vet.)

Here's a copy of the IDEXX pancreatitis treatment guidelines. Even if Zachary hasn't got pancreatitis it has a lot of valuable information on anti-nausea, anti-vomiting treatments. If your vet is giving you a prescription ask for an appetite stimulant as well as anti-nausea meds. (Mirtazapine caution: can cause serotonin syndrome - check for drug/food interactions with buprenorphine, SAMe supplements, or anything that can raise serotonin levels. Cyproheptadine is milder, doesn't last as long so more control over dosing, but check with your vet about any liver issues. FYI: Cyprohepatadine is used as an antidote for serotonin syndrome.)


Mogs
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I've been working all afternoon but checking on Zachary often so just reading these helpful responses, Thank-you! His insulin is Lantus. His appetite is always very good, as usual but found that he vomited his breakfast today (looks mostly undigested) and he had diarrhea sometime this afternoon. Now his BG is 294 and his appetite is good, my husband is giving him a small meal and he's very interested.
I just talked to his past vet who wants me to bring him in for a fructosamine test in the morning, the current vet whose message said that she will call back within 24 hours, and the one we hope will be more helpful for the future who has gone home for the day. Not a lot of help, right now
Now he looks comfortable but not quite normal. I'll see if we still have the ketone test strips since we used to test that instead of BG which one of the vets told us to do. We'll see if his food stays down. Not sure what to do about his usual insulin before bed, though.
I wish we had a vet who we trust. Both the current and the past 2 vets gave very unhelpful advice and I'm convinced that they don't know enough about diabetic cats. One we had to teach how to use the insulin pen. One told us to give an extra unit of Lantus in between usual doses if his BG went high which caused his hypoglycemic episode, recently. All told us not to do blood testing, ourselves. I'm very frustrated with the 3 vets we have taken him to in the past year since he was diagnosed. Now he's very sick and I don't know if I can trust any vet to really know what to do to help him.
If he looks worse or his food just won't stay down we'll take him to an emergency vet tonight. His BG just now is encouraging.
 
What we have says Diastix Reagent Strips for Urinalysis. I think that's different from ketone testing, right?
 
Elizabeth and Bertie said:
I agree with Tammy. If there is no improvement very soon then I think your kitty needs to see a vet.

How is Zachary's appetite?
~~~~His appetite is good.
Is he wanting to eat but then subsequently throwing up?
~~~~No, I'll see if his ;last small meal stays down.
Does he appear nauseous? (Lip licking/smacking; looking like he wants to eat but then walks away?)
~~~~No, eating well.

Could he be constipated?
~~~~No, had some diarrhea today.
Is he prone to furballs?
~~~~No, he isn't.

Does Zachary have any history of ketones?
~~~~I don't know. None of the vets tested or had us test ketones.
Do you have ketone test strips that you can test his pee with?
~~~~I have Diastix but I don't think that's the same. (?) We can go out and buy some this evening and test his urine.
Does his breath smell like normal kitty breath, or fruity like acetone?
~~~~Normal kitty breath

Sending well-wishes to your kitty, and a big hug to you.
~~~~Thank-you!
We're appreciative for any help you can offer.

Eliz
Click to expand...
 
Hi Cathy,

Thanks for the update. I'm glad to hear that Zachary's BG is down a bit and that he's interested in food. Sorry to hear that you've got vet stress, though.

Re test strips, assuming what you're looking at is the same as these, I think they only measure urine glucose levels. Dagnabits!!! If you have a pharmacy nearby you should be able to pick up Keto-diastix or similar.

I'd suggest posting on the Lantus & Levemir Insulin Support Group baord asking for dosing advice before this evening's insulin dose is due. Advise on the vomiting/diarrhoea problem in the opening post and give any BG data you have. Also post a link to this thread in the opening post of the new thread. (Go to the first post here and click on '#1' and it will pop up a box with the link you need.)

Are you doing a food change at the moment? If yes, maybe try to avoid feeding whatever caused the upset and give Zachary something you know agrees with him, and try feeding little and often (with a good-sized portion at PMPS time).

I do strongly recommend getting Zachary checked over by a vet:

1. to make sure he's not constipated (counterintuitive, but sometimes cats who are backed up may vomit and also liquid faeces may squeeze out around a stubborn stool and it can look like the cat has diarrhoea. Good info on this at www.felineconstipation.org.

2. to get a blood draw and check for pancreatitis (good idea to get a check for B12/folate levels at the same time). If you are changing diet, something in the new food could potentially trigger an episode of pancreatitis.

3. to check ketone status.

I hope he feels better soon.


Mogs
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Cathy Palmer said:
His appetite is always very good, as usual but found that he vomited his breakfast today (looks mostly undigested) and he had diarrhea sometime this afternoon. Now his BG is 294 and his appetite is good, my husband is giving him a small meal and he's very interested.
.
Click to expand...

Vomiting with diarrhea is symptomatic of pancreatitis. I would test for it. They can do a SpecfPLI but Squeaker has it so often that the Snap Test is good enough for us. If it does come back positive for panc; the standard treatment is sub-q fluids, anti nausea, anti acid, and for Squeaker we get B12 injections which work wonders for him. Pain meds may also be necessary.
 
Zachary and I just got home from going to a new vet. She seems like she might be experienced and helpful with a diabetic cat, although she did recommend changing his food to their prescription. (No.) She did a senior profile (I guess because he's a new patient,) tested for ketones which were negative, sent off a PLI test for pancreatitis which should come back in 3 days, gave subq. fluids, gave cerenia inj. for his nausea, told me to give 1/4 tab. of pepcid until until GI tract settles, and has me giving him 50mg of tylan because she felt inflammation in his GI tract and suspected a possible infection. She recommended continuing with his 1 unit of Lantus and after all this settles down consider increasing to 1.5. Zachary is eating well and very happy to be back home.
 
That sounds good! Glad you didn't fall for the prescription food, it's just not neccesary. But I wouldn't increase the insulin unless his BG warrants it. If you'll get spreadsheet set up, the people here can give you good dosing advice.
 
A very productive consult by the sound of things, Cathy. Good news about negative ketones! :)

With regard to Lantus dose increases, the general recommendation here is to increase in 0.25 unit increments (both AM and PM cycles) and then hold that dose for a number of days (unless any nadir BG is too low, in which case the cat qualifies for an immediate dose reduction). Adjusting in small steps helps to avoid the problem of skipping over the 'goldilocks' dose that is right for the kitty at that point in time. Too much insulin can look like too little insulin in that BG numbers may go higher if the dose is too high. From there, it can lead to a vicious circle where doses keep getting increased and keep numbers higher than they would be on the 'optimum' dose to suit the current needs of the cat.



Mogs
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Mogmom and Goofus said:
That sounds good! Glad you didn't fall for the prescription food, it's just not neccesary. But I wouldn't increase the insulin unless his BG warrants it. If you'll get spreadsheet set up, the people here can give you good dosing advice.
Click to expand...
~~~~Thanks! I do have a spreadsheet and I was finally successful at putting the link with my signature. : )
 
Critter Mom said:
A very productive consult by the sound of things, Cathy. Good news about negative ketones! :)

With regard to Lantus dose increases, the general recommendation here is to increase in 0.25 unit increments (both AM and PM cycles) and then hold that dose for a number of days (unless any nadir BG is too low, in which case the cat qualifies for an immediate dose reduction). Adjusting in small steps helps to avoid the problem of skipping over the 'goldilocks' dose that is right for the kitty at that point in time. Too much insulin can look like too little insulin in that BG numbers may go higher. From there, it can lead to a vicious circle where doses keep getting increased and keep numbers higher than they would be on the 'optimum' dose to suit the current needs of the cat.



Mogs
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Click to expand...
Thank-you, this is very good to know. I was planning to make .25 increments but the syringes only are marked with .5 and even that looks pretty hard to get accurate. I wonder if syringes with .25 are available in other countries. I'm going to look up the pharmacy in Canada that has been advised to see if they have more accurate syringes.
 
Hi Cathy,

I think the syringes with the half-unit markings are as good as it gets. It helps to get some form of magnifier to make it easier to judge the mid-point between graduation marks on the syringe. I got a cheap little jeweller's loupe to help me measure Saoirse's insulin doses. I learned how to ease small drops out of the syringe when Saoirse was on insulin first time around. I draw up more insulin than I need, flick the syringe to get any bubbles 'centred' (using the loupe to check). I then express most of the excess insulin. I then ease a teeny weeny droplet of insulin out, check with the loupe to see if the leading edge of the syringe plunger is where I'm aiming for, then rinse & repeat till I get the dose I'm measuring. Takes a little practice but it's doable. You basically need to decide where you consider the mid-point between graduation marks to be, and then stick to that for all measurements. Helps to write down a description of where you decide the mid-point to be as well so that you're as consistent as possible.

Even if you yourself are 100% accurate in measuring, there can be variances in where the graduation marks are printed on the syringes. Some people here use digital calipers to overcome this problem. If you post on the L&L support group's board you might get more tips about dose measurement.


Mogs
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The other vet, whom I haven't met, called to tell me Zachary's results and said that he would like to add a urine protein creatinine ratio with the urine sample that's already been taken yesterday and I agreed to it. He says that it will tell us if Zachary's kidney's are failing which he thinks might be the case from the results of another test done. He also wants us to bring Zachary back in for a glucose curve. I told him that we can do that ourselves at home since the stress of being at the office can effect their readings (plus what has already been done was over $600 on my credit card!) Is there any advantage to having the vet's office do the curve over us doing it at home? I did just do one 3 weeks ago after his hypoglycemic episode. Is kidney failure common with diabetic cats?
 
There is no benefit for a curve to be done at the vets office unless you don't have time in your schedule to be home to do it yourself. It is better to do it at home and not have vet stress influencing the numbers.

Unregulated diabetes can be hard on the other organs. Both are older kitty diseases so it may just be timing too. Many vets use the term "kidney failure" to encompass all CRD chronic renal disease. It can sound really scary to hear "failure" when a kitty in the early stages can have many good years left. Our Taz is over 18yrs old and has been in "kidney failure" for over 3 yrs now. Meds, subQ fluids, and bloodwork to monitor and she went back down to stage 2 (the borderline of normal) and has stayed there for quite some time now. Any cat with CRD I recommend not feeding Fancy Feast much, if at all, because of its high phosphorus. From your sigggy it doesn't look like you are feeding that so thats good.
 
If you do find that Zachary's kidney levels are elevated, it is good to find low carb that is low in phosphorous. The recommendation is 200 mg and below (or 1% below). There are some good low carb, low phosphorous wet food on the list. Also if you do find out that kidneys may be an issue, a great website to visit is http://felinecrf.org/
I hope Zachary will get better soon.
 
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