Dose Help Needed After Bounce

Hello. Malakai had a hypoglycemic emergency yesterday (reading of 34); seizures and all. He was hospitalized overnight. This morning, his blood level was 463. Is this most likely a bounce? If so, what should the dosage of insulin be?

 

Yes if you look at my ss you can see that Tempest fell very low (50) then bounced after that for a few days in the pink then red. I used slightly different dosing for her as she was really sensitive to insulin (they usually are after a hypo but she is a very low dose kitty Kat so don't copy mine) i kept halving her dose and then went to smaller increments so she stabilised but most kitties seem to take longer. I just got lucky coupled with brilliant info from here.

 

Agree. It is a bounce from low numbers he wasn't used to. I would do a restart at one unit, test and watch and see what his cycles look like. It takes awhile to see what he is going to do with the insulin.

 

As Malaki is newly diagnosed he will have been used to high numbers for some time before diagnosis, and cats tolerate high levels very well so it is better to start low with the insulin dose and take things gradually and not worry too much about high numbers to start with, as time goes by and you get more testing in the dose can then be adjusted accordingly, the lovely people on this board can guide you. 1 unit is a perfectly reasonable starting dose and Sue (together with a few others) has the experience to be able to advise you on dosing changes.

 

I see you got him home. I answered on you other thread which is here

http://www.felinediabetes.com/FDMB/threads/hypoglycemic-episode.163855/#post-1763821


It is best to only have one thread going per day. So people can see all responses in one place.

 

Malakai is not home yet, as his levels dropped from 463 at 6:30am, to 280 at 8:30am, to 90 at 11am. He was given one unit of insulin at 6:30am. They want to get one more reading at 3pm before releasing them. I wasn't supportive of them keeping him, but given the way his levels are dropping, I'm more comfortable with it. They are feeding him though, which will obviously make his levels elevate again.

I'm more confused than ever now. UGH!!!!

 

He's just coming off a bad hypo episode so he's ULTRA sensitive to insulin right now. He might only tolerate a dose of less than one unit for a time. You might see some crazy-making BGs in the aftermath but things should settle. It's really important to do those preshot and nadir tests once he's back home. More experienced PZers than I am might have a dose recommendation for you for tonight.

 

That is a big drop which suggests 1 unit was a bit much for him. If he were my cat I would skip tonight, as Prozinc lasts up to 14 hours or so, get him settled at home and see what the AM reading brings, if below 200 then definitely no shot. He is bouncing so if you can get your spreadsheet up and running there will be someone around to help.

 

I'd see what his level is when he gets home and relaxes. A 90 at the vet could be much lower at home. Looks like one unit might be too much.

 

I agree. It's possible he'll need a small dose...maybe like 0.25 or something depending on his level. I for sure would not give if he was under 200 for now.

 

The vet told me not to give any insulin if he was at 350 or under this morning (playing it super safe, which is totally good with me). If he was above 350, she said to give 1 unit. She also said that he may only need one dose per day. He was at 341 this morning (before eating), so I did not give any insulin. My question now though, is when *do* I give insulin? I will be monitoring his levels throughout the day (as I am off work today). I am scared to even give 1 unit. Should I wait until his normal dosing time (5pm), to see if his levels are above 350?

 

You need to do what works for you. We suggest not shooting under 200 in the beginning. 350 is a high no shoot number, above the number we consider the renal threshold - the range where the pancreas can heal. Giving ProZinc once daily is not a good idea. What is most likely to happen is that the insulin will work for 12 hours and then it will be out of his body, leaving him high for the next twelve hours. This creates a roller coaster effect from low ranges to high ones, which can't feel good.

Maybe try the conservative approach for a cycle or two, testing to see what his levels do. Then readjust the plan if needed. I am sorry but I think your vet does not seem very knowledgeable about feline diabetes - giving a large dose to a brand new diabetic, not knowing his numbers would be lower at home, considering giving insulin once daily (the ProZinc website contradicts this) and overreacting with a high no shoot number. But I know it is hard to go against your vet's advice. Maybe do some research on your own, on this site and others (cat info.org is a wonderful site written by a vet) and see what your "gut" says.

 

I am more confused than ever. This is advice from two different vets. And what makes things even more strange is the following:

Malakai's blood level at 6am was 342. I did NOT shoot. I fed him at 6am. I just took his levels again at 11am, and it's at 146 (WITHOUT insulin). What's going on??? Thank GOD I did not shoot.

Is there another type of insulin that is better for once a day administering?

 

Cat have a fast metabolism so there isn't an insulin suitable for once a day administration. Sometimes a hypo can help kick start the pancreas, the other explanation is that he started high this morning after a bounce and is now settling and more relaxed at home so stress could have also helped push the level up this morning. 146 is a good number and perfectly safe for him, can you grab a few more tests today? Have you changed his food at all?

 

That is interesting. Did he get insulin yesterday? This mornings number was high so if he got insulin yesterday, it is quite possible it is a bounce. And/or could be some help from his pancreas. Sometimes a harsh hypo can cause a pancreas to "wake up". May be an on/off situation.

Great that you are getting data and watching his numbers carefully. He is full of surprises, but home testing can help you stay on top of things.

 

Sue, the last time he had insulin was yesterday morning at 6am.
His reading at 3pm today was 256.

Alexi, I have not changed his food since learning he was diabetic.

I'm really confused as to what I should do if his levels are say, in the 400's tomorrow morning. I have to work, so cannot observe him. I'm terrified of him having another hypoglycemic episode.

 

So 6AM 342 no shot
11AM (+5) 146
3PM(+9) 256
Not bad with no insulin. How is Malakai feeling?

 

Hi Sharon, now I finally understand the +5, +9, etc. thing on the spreadsheet. LOL. I didn't get it before, and it was preventing me from using it. I'd been using my own spreadsheet. DUH!...to me!

Malakai is in great spirits. He's alert, responsive, affectionate, purring. His pupils are also NOT dilated. I know he feels yucky when his pupils are dilated (even in bright rooms).

Do you think that I need to feed him more times throughout the day? I only feed him twice a day now....because I work. I don't even know how I would be able to feed him three times per day, except to do two smaller meals at night (like at 5pm and 8pm). Idk... Just brainstorming.

I'm going to keep taking his levels throughout the evening.

 

The picture is pretty confusing. I think mainly because it is very early in this sugar dance and his body is adjusting after a hypo. And his pancreas might be confusing the picture.

I see two choices. Give a tiny bit of insulin if he is in the 300s/400s tomorrow. You might try to eyeball 0.25 It should keep him from going sky high but not be enough to create a problem. Or wait until you can monitor before giving insulin. If you work, that might need to be a night cycle, getting a before bed test and set the alarm so you can get that mid cycle number.

If you are going to wait to give insulin, I'd urge you to get ketone strips (the same kind humans use) and check his urine for ketones.

Just for reference, if using a human meter, we consider a cat regulated if he is in the mid 200s at preshot with nadirs (5-7 hours after the shot) in the low hundreds or double digits, but above 50 (hypo range). We suggest a new diabetic not get a shot if under 200. Once regulated, then you work to slowly get him in lower ranges toward remission.

 

To give meals when you're not home, some use an auto feeder. You can freeze some wet food and it will be thawed by the time the feeder opens. That will help you feel more confident too, knowing there's food available for him to eat if he feels the need. @Bobbie And Bubba has one and can tell you more.

 

Hey Anna. I use the PetSafe 5 auto feeder and it is a great tool for when you can't be home. You set the feeder up to open up and serve the food in the slots at the times you set it up for. It is better for diabetic cats to be fed more than twice a day. There is different opinions about that but I can say that I saw my cats numbers get more stable when I started feeding him 6 mini meals a day. I took the amount of calories he should be consuming and divided by 6 equal meals. That is where the Petsafe comes in handy. In warmer weather you can freeze the little mini meals so that by the time the slot opens to serve hours later, the food is thawed.

Here is a great formula for feeding. If you are happy with the weight that Malakai is right now, use that number in the following formula. If he needs to lose weight, use the weight you want to see him in this formula. It is the Weight X 13.5 + 70. So let's use the weight of 10 lbs as an example. It's 10 times 13.5 =135 + 70=205. 205 would be the kitties daily calories requirement and you would divide that by 6 or however many meals you want to give. Studies show that diabetic cats pancreas responds better to small frequent meals.

So glad that you are home testing to keep him safe and as others have said, after a hypo event they can become ultra sensitive to insulin. As a new diabetic , you don't want to shoot 200 or below.

Just one thing about the vets: Sadly they do not have a lot of experience with Feline Diabetes as most cat parents euthanize their animal with this diagnosis. This board has so much information and great advice and with out it, I think my cat would be dead .

Keep asking questions as that is how we all learn. And welcome!

 

Okay...so here were his readings for the day:
6am - 342
6am - meal
11am - 146
3pm - 256
5pm - 281
5pm - meal
7:30pm - 193
*NO INSULIN GIVEN ALL DAY. His levels drop after he eats.

Do you think it's possible that he's getting high readings because he's hungry...and his blood sugar is too low (so his body is overcompensating)?
I'm wondering Bobbie, if something like the auto feeder would be better for Malakai.

 

One of the ways we think we know the pancreas is working is that they drop rather than rise after eating. So this is a good sign. And yes, small frequent meals might help his pancreas out. I have the PetSafe 5 too and love it. I got mine at PetSmart. Others have said they'll match the price on Amazon, which tends to be a little cheaper.

 

Very nice!!!

 

Hi Anna,

I'm a bit late to the party as I've only just seen your post on the main forum. I'm very sorry to hear about how scary things have been and I'm very, very glad that Malakai's OK. I hope you're feeling a bit better too by now.

[Emphasis mine]

I have been looking at Malakai's spreadsheet and I see that his numbers are heading towards the normal range without any insulin over the last number of days. The comments quoted above are indicative of Malakai's pancreas pulsing insulin at mealtimes (hence the lowering of BG after meals).

If you try using a timed feeder to provide smaller, more frequent meals over the course of the day that might further help BG levels because there will be shorter periods between mealtime insulin pulses and that can help keep BG levels down in better numbers for a greater part of the day/night. BTW, Hill's m/d food is NOT low enough in carbs for a cat with diabetes. Which brings me to my main reason for posting ... ... ...

Please can you let us know EXACTLY how your vet arrived at the diabetes diagnosis. Specifically:

1. Was Malakai drinking and peeing much more than normal prior to Dx? If yes, for how long had he been doing so before you brought him to the vets for assessment?

2. Was Malakai excessively hungry at all?

3. Was Malakai losing weight?

4. How was Malakai's coat condition?

5. Did your vet run a fructosamine test as part of the diagnostics? If yes, what was the result?

6. What other tests did your vet perform?

7. Were there any other clinical signs supportive of a diabetes Dx (e.g. lethargy, depression).

The reason I'm asking is that I see from the spreadsheet that Malakai was suffering from a respiratory infection and I'm wondering about the soundness of the diabetes Dx. Infections can cause transient increases in BG levels.

A couple of further questions:

1. Did Malakai receive any treatments for the respiratory infection? If yes, can you let us know what they were, please?

2. Did the vet check Malakai's mouth to see whether there is any dental work needed / any gum inflammation? (These can also elevate BG levels.)

If Malakai were mine I'd be inclined to ask the vet to do some general diagnostics to check for respiratory infection, mouth health and urinary tract health. If there are any infections or inflammatory processes going on all of those could elevate BG levels and appropriate treatment(s) could help return Malakai's BG levels to a better range.


Mogs
.

 

PS ...

Just noted from your spreadsheet that Malakai is still getting some dry food. If you can eliminate that from his diet that would help matters, too. (You can use timed feeders to dispense wet food, BTW. )


Mogs
.

 

Hi Mogs! I first wanted to start by saying, "THANK YOU" for taking such detailed notice of Malakai and his symptoms. I don't know how to express how much it means to me that someone is showing such detailed interest. Maybe it's because I live in southern CA (where it is grossly overpopulated). To have someone actually care enough to ask the questions that you're asking is a miracle when it comes to me...let alone my fur baby.

I will try to answer your questions as thoroughly as possible. Keep in mind though, that Malakai is just a "number" (so to speak) at any vet's office. From what I see on these boards though, it seems to be a growing trend...sadly enough...

1. Malakai was peeing and drinking a lot more than normal. And he was getting clumps of litter all over the floor (sticky urine?). I'm a neat freak, and it was driving me crazy. Haha. Also, I had another cat die of kidney disease at age 16 (so I knew the sign of excessive thirst). In fact, I thought that Malakai too was suffering from kidney disease. Suspecting that it was kidney issues, I began searching for foods that were best for it. I changed from Blue Buffalo dry food to Wellness Core dry food (and limited his access to it). I also increased the wet food. It went on for a month or so before I took him to the vet.

2. He was not excessively hungry.

3. He had not started to lose weight (at that point).

4. His coat was how it had always been (not much change).

5, 6, & 7. I do not know what a fructosamine test is, so not sure if vet conducted it. He only told me that he conducted blood tests for kidneys, blood sugar, pancreas, etc. I did not ever receive a test-result read-out. I imagine that I could ask for one though. No? He only told me that his blood sugar was elevated, and that I should try the Hill's M/D (and completely eliminate the dry food). This was 7/29/16. He also advised to bring Malakai back if things worsened. Malakai really liked the Hill's M/D food and was doing well. His excessive drinking/peeing decreased greatly. However...after a few weeks, he began to become lethargic, began to lose weight, had dilated pupils, was depressed, would not eat (I actually force-fed him at times), his coat became dull (and un-groomed), and barely had enough strength to walk up the stairs or jump onto the bed. That's when I took him in again and told the vet that I wanted to start him on insulin. He was hospitalized for about three days (starting 8/17/16). The vet experimented with insulin levels and tested his blood glucose multiple times daily.

Malakai did not show signs of a respiratory infection until he came home from the hospital (about two days after coming home). We concluded that he had contracted a virus while there.

When Malakai had his hypoglycemic episode and was hospitalized again on 8/27/16, he was given three doses of penicillin. He did not have a fever though, and was still eating. They offered antibiotics to take home, but explained that it was a virus. We did not give antibiotics. He's totally over that now.

The ER hospital/vet did a lot of tests and gave me a print-out with a BUNCH of mumbo jumbo and language that I do not understand. Is there a specific acronym that I should be looking for? It indicates that he has mild dental disease.

And OH...I only gave him dry food because I was scared that his blood glucose level was too low. That morning, he was at 70. I'm TERRIFIED of him having a hypo incident again.

Thank you, thank you, thank you again for caring about Mali.

 

Glad to hear from you, Anna. I've just taken a sleeping tablet (chronic health issues here) so I'll review your post on the morrow. Thank you for the comprehensive reply; it will be a great help to us in our endeavours to help you and your beloved Malakai.

In the meantime can you please confirm that you are withholding insulin until further notice.


Mogs
.

 

Yes...that is correct. No insulin for Mali since his hypo incident.

 

Hey Anna, any possibility that you could upload the printout (not including any personal info of course). I ask because I really don't know what to look for, but some folks might...and if they could just review it, maybe it would help us all see what's going on?

Also, I'm a bit confused. What food are you currently feeding? (Sorry if I missed it...I'm exhausted. Been a long day and week here!).

 

Sure, I could upload it (though it's many pages)... I'll try to see what is relevant.

I am currently feeding him wet food only. I feed him Hills M/D and Fancy Feast (classics). I only fed him the dry food one time (a couple days ago), because his blood glucose level was at 70 (and I got scared).

 

We can all relate to that feeling only too well, Anna.

As long as he's not receiving any insulin that 70 is absolutely fine. Indeed, it's a great BG level.

Back later. Uploading the printout will be a great help.


Mogs
.

 

Here's the printout.