911 hypo

after feeding acted drunk then siezure so rubbed honey inside his mouth and came out of it..... 6 hrs after 1u dose what next

 

Did you test his blood sugar? I'd try to get him to eat some food and test again in 1/2 hour. Honey can wear off and you want to make sure he stays up.

 

Will test his bg.....this was right after 20 ml force feeding so will keep feeding. how much i don't know

 

tested with last alphatrak strip...84...will start using my relion confirm again.....just force fed him again the Hills AD with honey in it. Will test again in 30 min

 

Thinking good thoughts for you. From your spreadsheet, it looks like you've been having a rough time.

Does your vet have an after hours number that you can call?

Keep testing. From the Alphatrak test, his numbers look like they've just barely started into the normal level.

 

You want to keep him up above 68 on the AlphaTrak or 50 on the Relion. He's not at a dangerous point now, but honey or other high carbs can wear off in 2 hours or less. I'm not familiar with your insulin, but I think since he's 6 hours after his dose the insulin should be starting to wear off. Keep testing every 1/2 hour until he's over 80 on the Relion and then you can go to hourly testing unless he really zooms up. If you feed now, you only need to give a couple of teaspoons. You don't want to fill him up in case you need to feed him later.

 

Here's a link to the Hypo Instructions in case you need them. I found it was good to have this printed out, if for any reason I lost power or internet.

 

BJM's Glucometer Notes really help too.

 

No after hrs #. Have appt tomorrow. Wondering how much and often to force feed him to keep him in safe #s. It's +6 1/2 hrs on Prozinc. I dumped a lot of sugar with the honey and food with honey so will just stick with food onward. Thanks!

 

Just tested with Relion....117.....but I gave him a lot of honey. I fed him 20 ml Hills AD just before the episode and another 20 ml AD with honey after the honey got him back. I'll test again 30 min.

 

I'd keep testing for at least two hours. You want to make sure his numbers are stable a couple hours after you last fed honey. Test every half hour if between 50-80, go to every hour if over 80. If he goes below 50, feed the honey and food combo again. If after two hours his numbers are still rising, you can nap until morning. Post here for advice on what to shoot next. BJ had suggested a dosing scale on your other post, but tonight might change things.

 

Oops, I just posted as you did. He's over 80, you can probably wait for an hour before testing.

 

Too bad on the no after hours number. Just keep testing and feeding like @Wendy&Neko suggested. Keep a good eye on him. (I'm sure you're already doing that.)

I hope your vet appointment is early tomorrow. If not, you might call right after they open to see if they can get you in earlier.

 

Ok. Thank you for your help......that freaked me out.....doubt I'll sleep.

 

It's a 1:40 appt, but I'll be calling 1st thing.

 

Make sure you mention to the vet that he was showing hypo symptoms. Often we'll see kitties go below 50 but they won't show any signs other than being very hungry. Once you've gone through the process of testing and feeding to get Poncho through low numbers a couple of times, it'll get easier. You don't need an after hours number to do that. However, seizures are a concern. Quick thinking on your part to get him out of it fast.

 

A seizure would freak me out too. I hope the rest of your night is much less eventful.

 

His next dose is 4 1/2 hrs away. As stated before I had to switch to my Confirm so will be needing advice depending on his BG, but my guess is I'll probably be skipping.....BG will tell
New BG Confirm meter #.....217....
I'll get all the numbers up on SS when the dust settles. Switching to 12 hr SS but might go back to 8hr. Not sure about new vet now re insulin.

 

Good catch last night. Cats that have a symptomatic hypo are often extra sensitive to insulin afterwards. If you give him insulin today, you may want to reduce the dose. I don't have experience with the insulin you are using, but others who do will hopefully be along by the time your next shot is due.

 

Well done for getting through it. I think this indicates that you do need to keep testing his blood glucose so you can get an early warning of these drops.

 

I wasn't sure about giving him 1u with BG 139 so checked with vet and she said do it. .5 u might have been right.

 

He had a fast drop last week at the vets.....real sensitive now. Thanks.

 

Yes that blood glucose was very low to shoot 1 unit if you go by BJMS sliding scale. Especially if that was with the alpha trak.

I just wanted to repost it here:

This is BJM sliding scale using the alphatrak meter

So if poncho's blood Glucose was 139 was on the human meter then the suggested dose would have been 0.25. I am getting confused which meter you are using.

I do think you need to stick to a plan of action so that you are well prepared before an event occurs. Could you discuss the sliding scale with your vet over the phone and get an agreement. 1 unit was too much

 

His next dose is due now....5 1/2 hrs after Hypo. BG now is 423 on Relion Confirm (vet only gave me enough alphatrak strips until today's appt and last one was used after the incident) So any advice on dose? The vet doesn't get in til 10am, 3 hrs away. I'll call her office and see if they can get a hold of her. I'll make sure she sees the sliding scale info. Go ahead with .75 or wait till I talk to vet? I'm concerned about sensitivity now.

 

You are probably seeing a bounce. I honestly don't know about the dose. If 1 unit took him very low it would have to be lower than the last dose. Does he clear bounces quickly?

 

@Sienne and Gabby I see you are online. Is there any way you could advice on dose. There was a hypo incident last night. Should Chris just reduce by 0.25 to 0.75 prozinc. Sorry to throw you in at the deep end.

 

Okay I think I missed her. It's up to you Chris. If you can monitor and deal with a hypo then I think maybe the 0.75. You can test at +2 and and begin to steer any steep drop.

You still have relion test strips? Honey, etc.

 

Sorry I'm all over the place. Prozinc is slow acting so I'd be at the vets in 3 hrs. I'm going to have to also show the vet his spread sheet and scale. I'm concerned about ketones but afraid to guess the dose. Maybe safe to give .5. I'll wait a bit longer.....vets office is open soon but she wont be there for 2.75 hrs unless they can reach her.

 

I have a tablespoon left plus some food mixed with honey, plenty of test strips. I'm going to give him .5 I guess. I'm sorry to put you or anyone else on the spot. The vet should be more accessible and should have thought about the 2nd dose more.

 

Don't worry I know the desire for someone to just tell you what to do. Unfortunately I am not that experienced. If you are more comfortable with that then go for it. Something is better than nothing. You could give a fat 0.5. Going to the vets will probably raise his levels a little anyway.

I would write a list of all the things you want to discuss eg

The sliding scale
The need to do more blood tests than the vet suggested.
The pain relief
The anti nausea
The sub q's
The alternative insulin
B12 injection

 

I took his BG again and it read HI, so went ahead with 1 unit since his 1st preshot BG yesterday was 318 and he got 1 unit and did well. I'll take him to the vet after I feed him. He ate a little on his own earlier.

 

Good job Chris. It is sucha difficult a balancing act. This is where the sliding scale might work for you. If one unit is good when he is high, it may be too much when he is in better numbers. Keep an eye on him though and take his blood Glucose regularly

 

Thanks Sarah. I fed him 25 ml A/D and will check BG every 2 hrs until the vet appt. There's a pic of him and one of my dogs in the other thread....better times for sure.

 

Chris,
Since you were having trouble with swings in BS before on the 12 hour dosing (looked like it hit hard, and wore off too fast), you might never get good control with prozinc. It might be worth asking your vet to switch to a longer acting. They work much differently, and keep blood sugar more stable (less 500 going down to 50 sort of business). They also provide a better basal rate for cats prone to ketones.

 

I'm going to see what she says. She needs to study this forum. Thanks Meya14.

 

I agree with meya. I might hold off suggesting the vet study the forum But agree the knowledge base here is invaluable. Members eat, sleep and breathe diabetes.

The good times will return, you have to just stay strong. But I don't see the picture

 

It is possible that one of the long lasting depot insulins may work better for Poncho, and might help the numbers to level out a bit.
There are no guarantees though.

You would probably get longer duration; and if that's the case you should be able to give shots 12 hourly.
But one advantage of Prozinc and PZI insulins is their flexibility with regard to dosing. It's possible to change the dose much more quickly with these insulins, and to use a sliding scale if necessary.
And if Poncho is bouncing from blue numbers he would probably continue to bounce on a different insulin (until his body works out that the blues are an OK place to be).

Big hug to you, Chris.
You're doing a fantastic job in very difficult circumstances.
.

 

The pic is the last post in the 2/10 Poncho update thread.

 

Thanks Elizabeth. It's hard to see him so sick and I think his upper resp. problem is coming back stronger. I just hope by force feeding him he didn't inhale food. l

 

I'm assuming a severe hypo incident, even though treated fast and he's brought back, really knocks a cat down the next day. I'm wondering if that is why Poncho is lethargic, unless it's the buprenorphine oral pain med and/or his upper respiratory illness making a comeback.....or everything at once. Could the upper resp illness mess with his insulin to the point of sudden drop in BG? I need to finally get this URI' thing to go away.

 

I think the sudden drops and bounces make them feel a little off. When remi was on the pain relief he was pretty lethargic. I understood infections raise blood glucose not make them drop. Did the respiratory infection come on suddenly ?

 

I cant advise on your other concerns, and can't say for certain but when Hidey was taking buprenorphine he was always sleeping, or being extremely lovey and laying in my lap. Im sure having a fast drop in bg hasnt helped him with being lethargic as well.

 

He's been dealing with it since he was diagnosed jan 15. They just ignored it, saying it was most likely stress (while in ICU 4 days), left eye discharge and sniffles or the dust where we live (a warehouse space). Finally at my request they gave antibiotics, the day before they threw in the towel and took him off insulin.

 

I too would hold off on showing your vet the forum just yet. My vet who is the easiest I've read about in terms of not minding my input was a little iffy at first. Now he says he hasn't seen a cat better managed and when I asked him when he wants to see Max again he said 3-4 months. That's when he told me what a good job I'm doing and that he told his current 4th year vet student the same thing.

Will they give you ondansetron or cerenia? Max is on his 8th day and I am considering tapering tonight.

 

Chris, i think the missing couple of days in the spreadsheet were when Poncho was in the vet hospital, aren't they? would you just mark them as such so it's clear why there's no data. If you have info from those days, it'd be helpful to have something there.

With ketones still recently in the past, you want to continue giving as much insulin as is safe. With a recent hypo that included seizures and obvious symptoms, he's likely to be more sensitive to insulin than he was in the past. You are walking on a tightrope.

I wish you were getting more help from your vet, because this is a really serious situation and as much as everyone here wants to help you, i think you need a pro in this.

The bupe can be making him lethargic. It also could be from him feeling crummy.

Sending Poncho all my healing thoughts!

 

I mentioned the website when I showed her the sliding scale. I think she's heard of it. She said the mertazapine works as an anti nausea med so wouldn't give me ondansetron or cerenia. One thing that disturbed me today is that she thinks Poncho needs to be tested for Cushings and that given his age (14) pancreatitis, diabetes, possible Cushings his prognosis isn't good. So we'll see. When I got him home he begged me to open a can of food and he tore into it....most hungry I've seen him. He seems so weak and fragile. It's great you have Max well managed....this is a great forum with people who probably know more about diabetes than many vets.

 

I think the vet might have suggested that Chris didn't need to test when he first bought him back home.

 

Ah, well, of course here on FDMB we all are big on testing, and the sicker a cat is the more essential testing is. We've seen how important the testing is.

I saw your earlier discussion about whether or not the relion is accurate - the thing is that the only essential blood sugar numbers are low ones. It's critical you know if a cat goes low - under 50 on a human glucometer or under 68 on an AT2.

If a cat is high, it doesn't matter if the meter reads 350 or 450 or HI. You know they are high and that's good enough.

So, for your purposes, you're going to save a lot of $$ by using the Relion and be able to get more tests in - and data is critical with every diabetic cat, moreso when the cat is ill like Poncho. I'd stick with the relion. If your vet wants an AT test here and there, give it to her. But overall, i think you can feel ok using the Relion and not worry about its exact accuracy. Does that make sense?

 

Yes, that's when I dropped him off at the new vet and they unclogged him and started treatment to deal with his other issues. I'll see if I can get some number for those days. I'll update the SS to reflect those days. I need to go back to the 12 hr one for now so will be updating that too. I think what's really helping Poncho is the potassium laced sub q fluids. I'll post the scale she wants me to use when I get back.

 

I'm glad you've got him stabilized.
It is really important that the vet see how Poncho reacted to the aborted curve, ie, the dose has to be lower at lower numbers, or Poncho may crash.
The scale I provided seemed close to what he needed using the human glucometer and if you line up the estimates for the AlphaTrak next to them, she can see them side by side.
If she has e-mail, or can get on the internet from her office, getting her the link to your spreadsheet will show her how responsive he can be to the insulin.

What is making her think Cushings is possible? A key sign of that is very, very fragile skin that tears easily. Does Poncho have that? You hadn't mentioned it.

Here's some links and info from our high dose forum ... and Poncho is definitely NOT high dose!
"
http://www.cat-health-guide.org/felinecushingsdisease.html
http://www.cat-lovers-only.com/cushings-disease-in-cats.html

Cushing’s disease is caused by a tumor of either the pituitary or adrenal glands, causing the production of excess cortisol. Cortisol is a naturally-occurring chemical in the body, which helps the body respond to stress such as infection or pain. With Cushing’s disease, however, the body continues producing cortisol even when the stressor has been removed. This causes a number of problems one of which is insulin resistant diabetes.

One particular symptom that helps differentiate this disease from acromegaly so quickly is that Cushing’s causes very thin fragile skin that may tear easily and/or not heal well. Females are most often the target."

 

Sorry but mirtazapine doesn't work well enough alone for nausea. I don't know why some vets think that it does. People here know more about pancreatitis as well. I don't mean to be disrespectful but have you considered getting another opinion on this? Where do you live?

 

@tiffmaxee Chris has seen numerous vets over the past week or so, with varying helpfulness. You should see some of the earlier posts!

 

Sorry to hear that BJM. This is so unfair.

 

I completely agree with Elise on this. The one dose of mirtazapine that Saoirse had she was crazed with hunger (among other unpleasant side-effects - got the drop of my life when I discovered that night that mirtazapine can cause serotonin syndrome) but she was still licking her lips and pulling faces when eating. Appetite stimulants may get a cat to eat, but it doesn't automatically follow that the cat is no longer nauseated just because it's eating.

 

You are so right based upon my personal experiences and those of so many others.

 

Isn't cushings fairly rare in cats, acro much more common cause of diabetes?

The vet is probably thinking cushings due to the low K+ and high blood sugars which is a symptom of this disease. However, this is a symptom of diabetes with poor control in general, so I wouldn't worry as much that this test is going to be positive. He may just want to rule out, as cushings or acro can make treatment more complicated.

Many cats with either of these conditions are pretty high dose cats >7U twice a day of long acting. You cat seems to have a pretty quick response to much lower doses of insulin, that's a very promising sign.

 

BJM, the vet has the records from the previuos vet who ran the 2 failed curves but I don't know if she focused on themaZ

 

How is Pedro doing tonight?

Cushings is fairly rare in cats. It can also be caused by steroid use. We have one member who posts here occasionally with a Cushing's cat, but several cats with acromegaly. BTW, the current poster's Cushing's cat does not have skin that tears, but does have fur loss on his belly. There is usually some skin condition present like thin skin or tearing. Pot bellies, weight loss, muscle wasting and unkempt coat are common conditions in Cushings. Insulin resistance (high dose) may or may not be present. Unless these symptoms sound familiar, I don't think I'd proceed with the testing for it. It's complicated to test for.

 

I'm going to ask a mobile vet I've used if he'll prescribe the anti nausea meds discussed and I think he can test for Cushings cheaper.

 

I'd ask why they think he has Cushing's. It's rare in cats and may not be necessary to test for.

 

I don't see high insulin doses, nor mention of fragile easily tearing skin in any of your posts, Chris. I wouldn't spend money on a test without some good clinical reason to do so.

 

Hi Christoph,

I was worried that Saoirse might have Cushing's prior to her diabetes/pancreatitis Dx because she was pot-bellied and had fur loss on her tum. She had also started pulling fur from her right hand side. The vet who Dx'd her diabetes said that Cushing's is extremely rare in cats. WRT Saoirse, her tummy fur regrew when she was switched to a species-appropriate, grain-free diet (getting her allergy-tested next week). Also, the fur pulling was due to pain in her pancreas. Again the fur regrew when the inflammation died down during the course of her treatment (finding food that doesn't irritate the digestive tract is the trickiest part). FWIW, Saoirse responded really well to small doses of insulin.

 

Let me know if you strike out with the mobile vet. I'd mention the IDEXX ROUND TABLE article if given a hard time. Tell them you fear fatty liver disease and food aversions if he is fed while nauseous. Good luck.

 

She said his skin is very thin.

 

Will do, thanks.

 

Thin skin was the reason. I posted the Alphatrak 12 hr scale she wants me to follow and it seems reasonable, but I'm a novice at best. I'm being conservative with determining dose given BG reading after the hypo incident.

 

What's a cheap but good alternative to the Hills AD? I'm still force feeding even though he's starting to eat on his own and represents 75% of his daily intake. Do I stay with mid carb?

 

Where did you post the scale? Do you mean on the forum?

 

EVO wet foods are fairly high in calories compared to other brands.

 

I'll check it out. He's been eating some Friskies pate but is very finicky. Thanks.

I'm sorry Sarah, it was in a reply to BJM's #49 post....still trying to adjust to new sleep schedule so not thinking clearly.

 

Finicky appetite is due to nausea. Max is acting the same way so it means he's not quite ready for me to reduce his ondansetron that he's been on since this p0ancreatitis bout due to dental. I learned this with my first sick cat. Poor thing was nauseous but I didn't realize it because she wasn't vomiting.

 

I think your vet's sliding scale is too aggressive and is likely to send him into another hypo, especially as you switch to a lower carb food.
Shooting a full unit with a pre-shot of 139 was too much for him.

 

I'm tweaking it....ex: this am BG 300...o.5 unit instead of 1 full unit. Scale is too general so I'm drifting to next lower range if BG is on low end of range. I
Her recommended dose was too high given 139 and I double checked with her and she said ok to give. Next day she admitted her mistake and that she had realized 1 hr after shot she might have been too high but didn't contact me. I'm not sure now I want to stick with her, but right now she's giving Poncho the fluids, meds to climb out of the hole....so far so good, except for insulin issue. I wont let that happen again if I can help it.

 

Many of us disregard the vet on dosing and follow what works, often based on recommendations here.

You'll want to be eagle-eyed as Poncho eats more on his own as the changing carbohydrate levels may further reduce his insulin need.
An alternative is to use the food list from Cat Info and pick up some retail foods with similar carbohydrate levels as the A/D, then worry about reducing those once he is really stable again.

 

In the vet's favour, she did acknowledge her error to you. You need prescriptions. It can be a bit unnerving, but one thing I've learned the hard way is that when it comes to veterinary treatment one really does have to be an advocate for one's cat. You're recording Poncho's response to insulin in his spreadsheet so you've got data to back up any reservations you may have in the future about agressive dosing and perhaps you could review the data with your vet when discussing dosage. As is often said here, you're the one holding the syringe, and - most important of ally - you're the one that loves Poncho.

 

Thanks. It looks like the Friskies pate he's been eating is ok alternative. I welcome any recommendations from members as I'm still unsure of myself, but increasingly less so as I proceed and learn.

 

Friskies pates, except Mixed Grill, are all low carb; watch those glucose levels!

 

Most of his diet is the AD....he eats the Friskies on his own which is around 25% of daily food.

 

Trying to be conservative with new scale not working I think. Pre shot am BG was 300 with Alphatrak and gave 0.5 unit, pm +12 BG 428 gave 1 unit. The new scale called for 0.5 unit more. Will follow scale more closely next dose. He did have a good meal @ +10-10.5hrs but I didn't expect 428

 

I'm glad he's ok after the hypo, Chris. I agree with Eliz on the insulins for now. The prozinc allows you the flexibility to shoot the high numbers down. The longer duration insulins like Lantus and levemir need time to build the depot, usually, and aren't good at bringing down high numbers.

I think it's best to fine tune his scale with help from those experienced using prozinc or PZI.

 

Thanks Marje.

 

My sub q fluid bag lost it's air somehow and flattened so it's impossible to read the fluid level. I browsed the internet and found no way to introduce air. The bag I'm using has only one stem line, but there is a small "plug"-like thing on the front near the bottom I'm assuming is an injection port? Do I inject air there or turn it upside down and pop this "plug" then close it. Or do I turn upside down and pull the line out then back in?

 

No idea. Not sure introducing air is such a good idea as I would have thought it has to remain sterile.

I think I would start a new thread with a description of the help you need as not everyone will read this thread.

 

So is mixed grill medium or high carb?

 

Yes, I was concerned about contamination also. I started a new thread.....thanks!

 

Don't inject any air into the bag (bacteria). If you are able to hang it from something with a clothing hanger where it will free hang, even with the vacuum created, it should read the right reading on the markers. Try maybe a shower curtain rod or closet rod. As the bad gets emptier, the markers are harder to read, no way around it.

The lower numbers are meant to be read once this vacuum is created.

 

It's hanging....just deflated and hard to read while giving fluid. Thanks.

 

We hang our bag of sub-q fluids from a clothes hanger on the back of the dark wood bathroom door. The dark wood behind the bag makes it just a little easier to see where the fluid level is at, though I agree it does get more difficult as the bag gets emptier and deflates.

 

Hey Chris. Cute photo Hope poncho is doing okay

 

Thanks Sarah. Poncho is having a bad weekend....like he's shutting down, lethargic to the point of limp and very weak. I think he's been sliding since the hypo incident. I'm testing every 2 hrs or so since I was only able to get 20ml of food in him. +5 BG was 194 with Relion. I hope it's just a rough patch. Tomorrow morning we have a vet appt. I'm calling the mobile vet I use to see if he'll drop off some anti nausea meds. Prayers needed.

 

Fingers crossed for you.

 

Thanks BJM

 

I'd get some more labs drawn. Sudden weakness can be electrolytes. He had been eating a little on his own? Also, are you still testing for ketones?

 

What is the sliding scale you are using right now?

 

The scale from the vet. Friday night and yesterday I backed off the scale 0.5 due to BG was too close to lower range....so used that dose but the next pre shot numbers were high so this morning obeyed the scale. The BG@ +7 was 192 down from 194@ +5 Pre shot this morning was 371. He's still dealing with the URI for which he is taking doxicycline and that might be dragging him down. I started using the other 12 hr spread sheet.

 

Could you list that one again, plus the ones I generated so folks can give some feedback?

 

Her scale: Test 2x daily (12hrs) Alphatrak
BG <200 no shot
BG 200-300......0.5 u
BG 300-400......1 u
BG 400>..........1.5 u

Alphatrak Meter
538.5-615.....1.25 u
461.5-539......1
384.6-462.......75
307.7-385.........50
230.8-308 .........25

Human Meter
350-400......1.25u
300-350.......1.00
250-300........ .75
200-250........ .50
<200............. 0.25

 

Here are some of the foods that I give my cat, and they are all cheap and under 10 carbs:
Friskies - Special Diet Ocean Whitefish, Special Diet Turkey and Giblets, Turkey & Giblets Pate, Ocean Whitefish Pate, Chicken and Tuna Pate
Fancy Feast - Turkey & Giblet Pate, Ocean Whitefish Pate, Chicken Pate, Tender Liver and Chicken, Tender Beef and Liver, Chunky Turkey, Chunky Chicken, Trout Feast and the kitten pates

 

Thanks for the list. He seems most interested in seafood smells due to his sinus congestion but loses interest too fast due to that and probably nausea so I have to assist feed. He's taking doxicycline for it but I think his immune system is so weak the URI is hanging on. He goes back to the vet tomorrow for a checkup and I'm going to ask for an antibiotic injection. I fear he might have to go back on IV treatment.