3/15 Dimmu hypo

Discussion in 'Lantus / Levemir / Biosimilars' started by Dimmu & KL, Mar 15, 2018.

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  1. Dimmu & KL

    Dimmu & KL Member

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    3/09

    It's been another crazy week in the poop land. Dimmu was not able to pass stools and was clearly in pain on Monday so we brought him to the ER. The ER vet put him under and try to do a colon flush/enema, but barely got anything out, she then tried with Valium to relax the colon muscles more, but still, nothing. Er vet suggested surgical removal of his feces and kept him there for the night for observation. Dimmu was released on Tuesday morning and he practically stopped eating after he came home, and was very weak in his hind legs. He'd still try to go to the LB, but nothing came out.

    We called our regular vet, Dr. Dufour, to ask about the surgery and she wanted this done at the university (1hr away) because it's a high risk procedure. Got there Tuesday afternoon, the university vet planned another colon flush in the evening and wouldn't agree to surgical removal until they have tried everything else. She'd also do xray and ultrasound. Unfortunately, Dimmu's RBC was low at 450,000/L when the blood work came back. The vet then wanted to do a blood transfusion Wednesday morning to bring his RBC to a more stable state before anesthetizing him. She was suspecting IBD, but proposed a bone marrow biopsy to find the cause of anemia if she couldn't find an answer with ultrasound.

    The anesthetist came on Wednesday morning and decided Dimmu's general health was ok enough to receive anesthesia without blood transfusion, so they did the feces elimination and ultrasound in the afternoon. With the ultrasound they found a swollen lymph node in the GI tract, did a fine needle aspiration and this was when I called. The cytologist was not there, so they didn't know if the swollen lymph node was a reaction to the GI inflammation or lymphoma. We were so sad and scared last night when we visited him.

    We got an update this morning, and they confirmed the swollen lymph node was because of the GI inflammation (major relief!!!) and we need to do a diet change, because with the colon flush, they found quite some undigested bones and think raw diet is not suitable for Dimmu. We have an appointment with the nutritionist this afternoon, will see what he/she thinks.

    Dimmu has been on raw food since he weaned off milk, so a raw eater his whole life. He has constipation episodes 2 or 3 times a year, but always clears it himself, except for this time. He's more of a hoover then a chewer, so maybe it has something to do with that? But the fact that this all happened after the dental surgery really makes me wonder if it's because of the pain medications and AB's he got after the surgery. Does anyone have experience with raw feeding causing IBD/GI issues?

    Dimmu is very stressed and hostile now, didn't want to eat last night and this morning. His pre shot were around mid to high 200's, so they gave him 3U (1/2 of his regular dose). If he recovers good, he can come home today. If he's home and doesn't want to eat, what should I do feeding wise and insulin wise? Give him anti-nausea meds? Stall until he eats?
     
    Last edited: Mar 15, 2018
  2. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    OMG, what a week for you!
    I have no practical experience to offer, only the :bighug::bighug::bighug:.
    I heard that certain types of proteins - raw or cooked can cause it. If so the remedy is to try other types of proteins by trial and error.

    I think that @Wendy&Neko have experience with IBD and foods and with dosing, I hope she has some advise for you.

    Wishing Dimmu speedy recovery and good appy!
     
  3. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I am so sorry you've had to go through so much with Dimmu. :bighug: Poor baby.

    OK, where to start. First of all, you can't diagnose lymphoma vs IBD with a fine needle aspirate. You have to do either a biopsy or endoscopy. I am sorry they didn't do a biopsy when they did the feces elimination since they would have been right there. :banghead: GI inflammation can be caused by either IBD or SCL (small cell lymphoma). Due to Neko's heart condition, she could not undergo anesthesia, so could not get a proper diagnosis. Has Dimmu been losing any weight lately? Has the vet suggested a GI blood panel to find out his cobalimin/folate levels?

    Next, the raw food does not contribute to IBD/GI issues. If there are allergies to proteins (IBD), it's the specific protein you need to address. Fortunately with raw food, there are lots of protein options out there. One thing you might want to consider is a raw diet that used eggshell calcium instead of bones. Some cats have problems passing bones. Here's a good web site on raw feeding for IBD cats.

    As for dose, you are probably safe giving him just half dose (3 u) if you want to tonight. Cats undergoing anesthesia who cannot eat can get 1/2 dose. Not all insulin goes to counteract the injested carbs. Then if he's eating better tomorrow, go back to his regular dose. Is he showing any signs of nausea?
     
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  4. Sean & Rufus

    Sean & Rufus Well-Known Member

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    Sounds rough! How incredibly stressful. Feel better soon, Dimmu!
     
  5. Dimmu & KL

    Dimmu & KL Member

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    He tested 49, gave him treat and syrup. what else should I do?
     
  6. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Test again in half an hour. Take a deep breath. Below 50 is our "take action" number. He's not in dangerous numbers yet. What kind of treat and how much syrup?
     
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  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I would also have retested. Any time you get a number that seems out of place, it's good idea to retest. Sometimes if you have too little blood, you can get artificially low numbers. What type of meter are you using?
     
  8. Dimmu & KL

    Dimmu & KL Member

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    I retested right away, it was 49. He got 1/2 tea spoon and one freeze dried treat.
     
  9. Dimmu & KL

    Dimmu & KL Member

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    We use a human meter, bayer contour xt
     
  10. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Sorry, I keep thinking of things. What point in the cycle are you? ie. how many hours ago did he get insulin? Could you update the spreadsheet?

    A "low numbers" event is not a hypo unless they are showing hypo symptoms. Is Dimmu showing any signs? Cats not on insulin can test in the 40's, we just don't want our kitties on insulin to be there as it gives no room for error. A low numbers event is also not a 911. We've save that for medical emergencies. Once you've got someones attention, you can take off the 911.

    If you don't have high carb food around, usually a drop or two of syrup (or honey) on regular low carb food will make high carb.

    Glad you retested.
     
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  11. Dimmu & KL

    Dimmu & KL Member

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    I updated the SS. his last shot was at the hospital this morning, 12 hrs ago. He didn't eat last night and this morning, so they gave him 3u (instead of 6u) this morning. After he came home, he was walking around, very restless.
     
  12. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    If it's been 15 min since he eaten, please retest and tell us what exactly has he eaten - and how much syrup.
     
  13. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    I would wait 20-30 minutes to retest. It takes 20-30 minutes for the carbs to go from the plate to the bloodstream.
     
  14. Dimmu & KL

    Dimmu & KL Member

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    20:23: 41
     
  15. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    :eek:

    add little more honey or syrup. He needs to stay above 50 to be safe.
     
  16. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    He's gone down, so I would give another couple drops of syrup or honey on his regular low carb food and test again in 20-30 minutes. It think you will be skipping the shot tonight, but we need him up first.

    Are you sure they gave 3 units at the hospital this morning? We had one kitty here that was supposed to get 0.5 units and they gave 5 units. :banghead:
     
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  17. Dimmu & KL

    Dimmu & KL Member

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    I checked twice with them today, and the Lantus vial they gave back had about the right amount left. Will call them to check again.
    Dimmu is shivering
     
  18. Dimmu & KL

    Dimmu & KL Member

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    It was 3U this morning, and his AMPS was almost 300.
     
  19. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Shivering isn't good. How much of his regular food has he had? We don't want to fill him up, in case you need him to eat later, but if he'll eat a couple tsps, that will help.
     
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  20. Dimmu & KL

    Dimmu & KL Member

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    20:40 50
     
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  21. Dimmu & KL

    Dimmu & KL Member

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    He had only about 1 tbsp since he came home, didn't really wanna eat. We are giving him syrup and freeze dried treats.
     
  22. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    that's good.
    The syrup will be out of the system quickly. The dry treats will stay longer.
    Taking another test in 20 - 30 min after he's done eating is needed.
     
  23. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Glad he came up a bit. Wet food/protein will help sustain numbers. It'll help if he'll eat a bit more.
     
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  24. Dimmu & KL

    Dimmu & KL Member

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    20:58 1 T canned food+1 freeze dried treat
     
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  25. Dimmu & KL

    Dimmu & KL Member

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    21:03 56
     
  26. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Whew, you can go 30 minutes now before testing again.

    Tonight he earned a reduction, down to 2.75 units. Would have been nice to see some tests during the cycle at the hospital.
     
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  27. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Nice, but if I am not mistaken about the time the food has not reached the bloodstream yet. You may need to retest later to make sure he stays above 50.
     
  28. Dimmu & KL

    Dimmu & KL Member

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    How much does he have to eat?
     
  29. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    small portions to beat the low number and keep him above 50. Ideally, if after two hours without food he is above - then he is safe. ETA: if the following tests reveal lowering - a bit extra food. If stays level or goes up - feed at his usual time/amount.
     
  30. Dimmu & KL

    Dimmu & KL Member

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    He doesn't really want to eat, though. We are force feeding a bit now
     
  31. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Since this is your first "low numbers" event, I would take good notes on how much of what food you fed, and when. Cats differ in how carb sensitive they are, so what works for one cat may not work for the other.

    You do want him to be two hours above 50, without giving high carb food, before you know he's safe. The syrup takes about 2 hours to get out of the system, so we want to make sure his numbers don't go back down when the syrup wears off. Sometimes it's a little less than 2 hours.

    As long as he's above 50 and has eaten a bit, you don't need to force it.
     
  32. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Some cats love Parmesan cheese.
    If you have it - grate and sprinkle a little on top of his reg food - mix in a little bit so he won't just skim the cheese and leave the food.
     
  33. Dimmu & KL

    Dimmu & KL Member

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    21:40 56
     
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  34. Dimmu & KL

    Dimmu & KL Member

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    Last drop of syrup was at 21:00. We have been feeding small bites ever since, so that's 1 hr 45 mins now. Should we continue feeding small amount LC food and retest in 3o mins, 30 mins later again and 1 hr later again?
     
  35. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    If it's been almost two hours since the last syrup, he's only had low carb since then? You can retest in 30, and if he's still flat or up, go to a one hour test. Sounds like you've had almost two hours without much carbs. Are you feeding just his regular raw?
     
  36. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    No, unless he is hungry and asks or if tests lower than 56 - then offer a little of food
     
  37. Dimmu & KL

    Dimmu & KL Member

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    Wendy and Tanya. Thank you so so much for staying with us through this. It's scary as hell and so glad we have some very calm and experience guidance for Dimmu's first hypo episode. Gonna retest in 15 mins.
     
  38. Dimmu & KL

    Dimmu & KL Member

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    It's only been an hour since the last drop of syrup. He didn't want his regular raw, so we gave him low carb canned food and freeze dried treats.
     
  39. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    :bighug: I know I'v e been there...:blackeye::blackeye:

    I am so extremely happy that @Wendy&Neko was online and able to respond to you! Thank you Wendy!
    What are you going to do with the dose for tonight - or have you decided to skip?
     
  40. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    You should skip tonight. It's way past PMPS time.
    In that case, test in 1/2 hour, then another 1/2 hour. If he's still up, you can go to 1 hour, and if he's up or still flat, you can take it easy on testing.

    The spreadsheet update will be a little challenging. You can stack multiple tests in the same cell if they are during the same hour. Just separate with a ";". You can put NS (no shot) or Skip in the Units column, so we know you deliberately chose not to shoot.
     
  41. Dimmu & KL

    Dimmu & KL Member

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    22:15 54
     
  42. Dimmu & KL

    Dimmu & KL Member

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    Will update the SS when I can. He's not really going higher, maybe it's the syrup weaning. We are going to feed more LC wet food
     
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  43. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Don't fill him up too much. He could be just surfing. Neko used to surf lower 50's for hours in the middle of the night. :rolleyes:

    After you've done this a few more times, you'll get a better feel for how often you have to feed and test to keep Dimmu safe. How is he acting now? Over the shivers?

    Just thinking of things, did he have an anesthesia today at the clinic? Certain types of induction drugs can lower the BG.
     
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  44. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Definetely good idea to skip tonight.
    If he is very high close to his next injection time you can do shot an hour earlier - if no conflicts with your schedule.
    That 54 is probably yet syrup influenced, hence the additional testing.
     
  45. Dimmu & KL

    Dimmu & KL Member

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    22:50 51, dropped a bit again... He is over the shivers and is very tired and sleepy. He didn't have an anesthesia today, it was yesterday afternoon, so 30 hrs ago.
     
  46. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    The numbers you are getting are all within meter variance. He is "surfing". Dimmu is not used to green numbers. Often they will feel out of sorts the first time they see them while on insulin. Neko would hide under the bed. Shouldn't be anethesia causing the lower numbers.
     
  47. Dimmu & KL

    Dimmu & KL Member

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    PM+3.75: 63. Phew. SS updated.
    He almost didn't eat for 48 hrs while he's hospitalized, about only 2.5 oz in total. Guess the low numbers have to do with it, too. The first thing we did when we came home is block the access under bed. It's not nice for him, but we knew it'd be a fight if we have to drag him out, and we wanted to be able to monitor him at all time. Luckily he's sleeping pretty peacefully in bed now. Thank you guys again, I really would have freaked out if it's not for your help! :bighug:
     
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  48. Dimmu & KL

    Dimmu & KL Member

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    How often should I test tonight? Planning on every 1 1/2 to 2 hours, given that he is in a safe range of course, is that ok? If he still doesn't want to eat tomorrow, do I give him the reduced shot of 2.75U? Or should I stall until he eats? Do I give his shot tomorrow if his AMPS is green?
     
  49. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Given that he is coming up, and you didn't give a shot tonight, I would test one more, in about an hour. As long as he's the same or higher, then you can go to bed.

    How many hours until your normal AMPS? Wondering if I will still be up to help. It's hard to say what to do when guessing what the numbers will be.
     
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  50. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    it maybe too much if he has eaten. Tak another one in an hour and if he hold and eats or if he stedily going up I think you can call it a night. It must be very late @your place.
    Take a late in the cycle test - maybe +10.5? and post for help here. You'll have hour and a half to get to talk to someone about dosing.
     
  51. Dimmu & KL

    Dimmu & KL Member

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    Will do that! Thank you so much.
     
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  52. Dimmu & KL

    Dimmu & KL Member

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    +5: 110. Guess we can have a few hours of sleep now, it's 7 hours until his next shot. Will keep posting his BG. Thank you and good night, Wendy. Really appreciate your help.
     
  53. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    No worries. The first lows are always very stressful. We all remember that feelng. :bighug: You did a great job given that he didn't want to eat. Looks like the bounce is starting. I'd think you can wait until +11 or +11.5 for the next test.
     
  54. Dimmu & KL

    Dimmu & KL Member

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    He got a lot higher during the night. PM+8: 227; AMPS: 265. Shot 2.75 U? Hope he will eat.....
     
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