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gothicfeline

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We had some serious adventures with our diabetic cat a couple nights ago. We're recovering and seem to be out of the woods (we hope), but now I'm looking for advice or opinions or other people's experiences. Basically, on Thursday he got his very first dose of insulin, which was two units of Lantus. We have checked, double checked, re-checked, and rather obsessively gone over it since then, and as far as we can tell we gave him exactly the amount we were supposed to give. However, a few hours after he got the insulin he went hypoglycemic and we had to rush him to the emergency vet. We were told he bottomed out at 36 before finally coming back up again (and that bottoming out happened after they had him on the dextrose drip. gah).

We took him home last night and he was doing loads better, he ate, and then he started straining and vomiting. I called the vet place and was told that it was probably remnants of diarrhea from the hypoglycemic crisis, and to keep an eye on him but not worry yet. This morning that's all passed, and he's just acting tired. Not much appetite at this point, but that could be from having such a rough night. Right now the main thing I'm wondering is if there is some point that I should really push food on him. I'm guessing he's ok so far, but I am really new to all of this.

Anyway, apparently all that shouldn't have happened. A very small dose, his very first dose ever, and his blood sugar totally crashed. Nobody has any idea of what's going on! The plan is to leave him off insulin for a while, and in around two weeks get a fructosamine test and then go from there.

ETA: I've left out loads of details in order to try to keep this short. Feel free to ask anything if I've left out anything important or something.
 
Absolutely the best thing in the world you can do for him is get a human meter and start testing him at home...obviously 2u was way too much insulin for him, even if you are absolutely sure you gave the right amount. It is also way too high of a starting dose, but was probably based off the numbers the vet was seeing in the clinic where your cat was under stress (barking dogs, strange smells, noises etc), then you get him home, he relaxes in the familiar surroundings and his numbers down and you have the problems you just lived through.

Taking him completely off insulin, may not be the answer either, because if he truly is a diabetic, he needs that insulin to be able for his body to process his food correctly, but the dose does need to be reduced way down, but without readings at home it is difficult for us to tell you how much it needs to be reduced too. Lantus is an excellent insulin for use in cats but it has to be given at the correct amount based on blood glucose readings taken at home when the cat is relaxed in their normal settings.

Mel, Maxwell, Musette & The Fur Gang
 
We do have a human meter, and while he was in the emergency room they did a few comparisons of our meter to their meter. Ours tends to show about 30% lower than theirs, but that is something we can correct for easily enough. The idea that he might need a much lower dose of insulin is one of the ideas being floated (along with possibly a different insulin, and possibly that they were wrong about the diabetes and there's something else going on). My bf (Nee) and I are planning on testing regularly at home just to get a baseline idea of what his blood sugars are like, plus the fructosamine test in a few weeks. Honestly, right now we really don't know what his BG is at home and relaxed. It's something we need to start tracking (and will be tonight. we checked last night, but it was only a few hours after bringing him home, so we were expecting hyperglycemia anyway). Thanks for your reply. ^_^
 
I cannot begin to tell you how your story sounds just like mine. Thankfully, the good people on this site are wonderful, supportive and knowledgeable. Roy had a Dx of diabetes at the vet...must have been 3 weeks ago or so (I forget exactly)...the 2nd time he was shot w/ 2 units BANG! 2am in the morning...a trip to the animal hospital at 3:30 in the morning...I got wonderful support here...and I shall never, ever forget it.

To make a long story short, Roy's diet has been changed, he is OTJ and seems fine for a 19 year old cat. I tell you tho, during the period when he was getting insulin, being taken to the Vet, the hospital, having his Mom all upset did take a toll on him.

I still test him every day just for peace of mind.

Listen to the good folks on here, they won't steer you wrong....ask as many questions as you want and if you do not understand something, say you do not understand and someone here will explain whatever it is until you do understand.

Kindest regards.
 
RoysMum said:
To make a long story short, Roy's diet has been changed, he is OTJ and seems fine for a 19 year old cat. I tell you tho, during the period when he was getting insulin, being taken to the Vet, the hospital, having his Mom all upset did take a toll on him.
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I'm sorry, I've been looking around and I cannot figure out what OTJ means. 'Off the juice'? Also, out of curiosity, what are you feeding him now?

I am still looking into cat food options. I've grabbed Dr. Lynne's list and will be going to the store at some point. About a week ago we switched him to Nature's Variety Instinct, which seems to be doing good things. I just don't yet know if we're going to stick with that or try something different or just start making our own.
 
What was he eating before the switch? The Instinct is probably lower carbs than what he was getting.

Any time you change food to a lower carb food you have to watch the BGs (blood glucose numbers) because they will come down naturally.

Your cat's ideal starting dose could even be just 1/2 of a unit. Many cats start Lantus on just 1 Unit and they go up or down from there depending on how their BGs are during the day.

OTJ - off the juice is just a cute way of saying in remission, no longer needing insulin, the insulin being the juice.

Are you going to switch to canned food only? Is the Instinct a dry or canned food?
 
tuckers mom said:
What was he eating before the switch? The Instinct is probably lower carbs than what he was getting.
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Before the switch he was on Fancy Feast Elegant Medleys. Yeah, I know, not so good.

Any time you change food to a lower carb food you have to watch the BGs (blood glucose numbers) because they will come down naturally.
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Yeah... this is actually directly related to a significant frustration I've been having with our veterinary office. Short story - when diagnosed his BG was 389. It took us almost a week to pull everything together and start him on insulin. The day before we were going to start we grabbed a meter and tested him, and it read 154. (in retrospect I now know that I should add 30% to that number, but that's still a lot lower). So we brought him to the vet to get tested again, because that was quite a drop. They got 286, which was much higher than ours, but much lower than they had gotten even a week ago. Their response to this: high is high, it's not much of a change, you MUST give him insulin that very night, and it MUST be two units.

I really really wish I had pushed harder about the 100 pt drop. I wish I hadn't put aside my skepticism, because doing as we were told clearly didn't go well.

Your cat's ideal starting dose could even be just 1/2 of a unit. Many cats start Lantus on just 1 Unit and they go up or down from there depending on how their BGs are during the day.
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Thank you for this. I am definitely going to be bringing this up with my vet.

Are you going to switch to canned food only? Is the Instinct a dry or canned food?
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The Instinct is canned. There is dry food available, but Genzi lost almost all interest in it when we switched to the Instinct, and lost even more interest in it when we started feeding him twice a day.
 
When you got the 30% difference in the meters, how did you get that? Did you bring your meter to the vet and you tested at the same time or did you just share numbers? The Reason I ask i because the bg raises a lot at the vet. My cat Props number raises like crazy. I can test at home 5 minutters before we go to the vet, and she is 89, 20 minutes later at the vet she is 300.
 
When we had to take Genzi to the emergency room, we brought our meter along with us. Then a couple times they used our meter at the same time they used theirs, to get a direct comparison. Both low and high ours was around 30 or 35% off. I played with the numbers and learned that if I multiplied the number from our meter by 1.35 I'd get a result very close to their number.
 
just wanted to throw out there that you do NOT need to change insulins since you said that was one of the ideas that was floating around out there. You DO need to reduce dose. And it should have been 1 unit to begin with.
I don't know why veterinarians ALWAYS seem to make the starting dose too high. We see it over and over again. 1 unit is the starting point.
Thank god you caught it and got right on it. Good for you and your gothic feline.
Lori
 
Now that you've switched to the canned only which is a grain free your kitty might go into remission very quickly.

When we take our cats to the vet they are often stressed, unless you have a kitty like my late Tucker, he used to love the vet so much he could hang out there for hours even with the dogs. Most cats get nervous and to account for this we would add about 100 points to the blood sugar. So the 286 your vet got could have been more like 186 if we account for the stress.

I would suggest that you don't worry about the 30% on your meter, just trust your meter, trust the numbers and dose going by that. If you try to account for the 20% variance up or down allowed by government standards and then account for 30% at the one clinic you're going to drive yourself crazy. Just watch the numbers on your meter.

When is he due for his next shot? Have you thought about what dose you'll give tonight?
 
tuckers mom said:
When is he due for his next shot? Have you thought about what dose you'll give tonight?
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Right now the plan is to leave him off insulin for a while, and then get a fructosamine test. Apparently our vet did not do one of those when they first diagnosed him.

And as a more general update - he has not eaten all day. It is currently his usual dinner time and I gave him a little bit of the gooshey he's been liking, and he snubbed it.
:( Now I am trying to figure out just how worried I should be. He might still just be recovering from the past couple of days.
 
When did he last have insulin? Can you get his BG just to see how he's feeling?

If his belly is aching you could try Pepcid AC (famotidine), a 1/4 tablet. I would also try some of his old food, maybe that would entice him to eat. You could microwave the Instinct, the scent would be more pronounced and that might help. Parmesian cheese sprinkled on his food could help, maybe some catnip sprinkled on it. If he continues not to eat, you could get some baby food (without onions or garlic) and force feed a little.

I wouldn't go to crazy on force feeding until I was sure he was not blocked, he may need to see a vet if he doesn't eat soon. For instance if he drinks water and that comes right back up, that could be a block, same with the food.

In some cases, just helping them get kickstarted eating gets them eating regularly again. The Medleys might be what he needs to kickstart his appetite.

You can get a fructosamene test, but it won't tell you a lot. If he's high some days, low others days, this gives an average for a few weeks, the average would be okay. Your own BGs taken at home will give you a much better picture on a day to day basis and help you see how he is doing and it won't cost you a lot of money to do that.
 
Also all meters have a plus/minus of 20% so you can get two numbers that seem very different and yet are in fact within that margin of error. Also a human meter reads slightly lower than a pet only meter. For example on a human meter a normal bloodsugar range for a cat is 40-150, on a pet only meter which is caliberated for a cat's blood the normal range is 50-170.

I know I have one non-diabetic cat here that when I test her at home ( yes, I have been known to test all 11 of my non-diabetics) she stays right around 45-57, yet she is extremely high-strung and if tested at the vet's will be well into the 200s. So even the readings your vet was getting in his office would make me question if your cat was truly a diabetic, or if diabetic perhaps only borderline. I know work part-time at my vet's office and he won't even consider saying a cat is diabetic unless we get an in office reading of 300 or higher, simply because of the stress factor. And then even with a reading of 300 will order further test to rule out things like infection, bad teeth etc before starting a cat on insulin.

Now as far as food goes I have two diabetics, Maxwell who has been in remission and off insulin now for a year by simply putting him on Friskies pate style canned cat food. Musette however is still insulin dependent and is still a work in progress to figure what combination of food and insulin will work for her. However I do know lots of folks here feed their diabetic cats, Friskies, 9-lives, and Fancy Feast Classics. You just want to stick to the pate-style and avoid anything that says grilled, marinated, or in gravy. The basic idea is to stay below 10% carbs and with Maxwell I found I needed to stay below 7% but we do already have a list with it all figured out for you.
Binky's List is what a lot of us use when we go shopping for our sugarcats and it is found here: http://binkyspage.tripod.com/canfood.html

Mel, Maxwell, Musette & The Fur Gang
 
I suggest you keep testing even though you are not giving insulin right now. You need to get some numbers to take to the vet. Going to the vet with a bunch of numbers will help the vet work with you to establish a safe treatment plan. When my vet wanted me to up the insulin too much I would just tell her I was uncomfortable doing that and wanted to try smaller increases. And don't give insulin unless the BG is over 200.

As to the discrepancy between the meters, meters are legally allowed a 20% variation. At home you are looking for trends.
 
Maggies Mom Debby said:
I suggest you keep testing even though you are not giving insulin right now.
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Oh, very much agree, and that is totally the plan. We figure we'll test him around 11ish at night (we're both night owls) as that's around 5-6 hours after he typically has dinner.
 
Our meter is a TrueResult from CVS. Just something we grabbed, honestly. Our main vet uses Alpha Trak. I don't know what the emergency vet used.

We are not currently testing for ketones, but we have been trying to figure out if there's a way we can do so. Genzi tends to be a shy pee-er.
 
The meters with "True" in the name tend to be a pain in the rear.

Walmart's Relion Ultima has an excellent rating from Consumer Reports and the test strips run $36 per 100, so it is very cost effective.

If you don't shop Walmart (I don't), the Maxima AST and Maxima Infinity are good meters and about the same price for test strips. I've only seen them available online, so you need to plan ahead so you don't run out.
 
The Relion CONTOUR is much better than the Ultima. We've tried both and not only dos the Ultima take more blood, it draws extremely slow. KT can get in a good ear flick before it ever quits needing blood.

Welcome to our world! It's a VERY special place!
 
If you're not a WalMart fan, the Glucocard 01 is the exact same thing as the ReliOn Confirm (Arkray USA makes both of them) and may be purchased on the web. One site is American Diabetes Wholesale ADW sells supplies for other meters too, as do a number of vendors in the Affiliates link on the header of this page.
 
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