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Help!! Hyperglycemic Hyperosmolar syndrome

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Tanyacatz, Dec 2, 2018.

  1. Tanyacatz

    Tanyacatz New Member

    Joined:
    Mar 11, 2016
    My kitty (Tessa) has been struggling for years with uncontrolled diabetes, and she was just diagnosed with hyperglycemic hyperosmolar syndrome a few days ago. She has been very unsteady and weak in her legs, and is now peeing on pee pads, and when pooping she usually Falls around in the litter box... It is just heartbreaking to watch. I am giving her 100 mls of Sub-Q fluids daily, and she has been on 5 units of Lantus BID for more than a week. I had to have a kitty sitter come over on Friday night to give her her shot, and had her check her BG at that time... Her BG came in at 11.3 so we opted to only give her two units of Lantus that night. When I got home the next morning I realized that the kitty sitter had used the incorrect code on the alphatrak meter, so her BG was probably more in the 16 range. I opted to give her 2.5 units that morning, and did a curve on her throughout the day, with her lowest being 14.9 and her highest 22.4 in the evening, so I gave her 4 units in the evening. This morning she was at 25.2, so I bumped her up to 5 units, as I am now thinking that I shouldn't have reduced her when the kitty sitter was over, as she has had constantly high BGs (20s-30s) until putting her on the five units for the past week, and seeing her lower BGs from the curve I just did yesterday... But she is still awfully weak, and staggers around. I have an appointment tomorrow with the vet, and may consider euthanasia if the vet thinks that there is no hope for quality of life and her gaining back her strength and litter box continence. I suspect that she may have Cushing's Disease, but she has not been checked for that yet... She was tested for acromegaly a couple of years ago, and she was on the high side of normal, but the vet also wonders if that may have been early signs of acromegaly, as well. Any suggestions would be greatly appreciated.
     
  2. majandra

    majandra Well-Known Member

    Joined:
    Oct 11, 2018
    I can't offer much for suggestions, but I can give well wishes *hug*
    I hope your vet finds some treatable answers for you.
     
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  3. Bronx's dad

    Bronx's dad Well-Known Member

    Joined:
    Nov 30, 2016
    Prayers for Tessa :bighug::bighug::bighug:
     
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  4. Bronx's dad

    Bronx's dad Well-Known Member

    Joined:
    Nov 30, 2016
    If the hind leg weakness is caused by neuropathy from diabetes, that can be reversed with B-12 in the correct form (many use Zobaline), along with getting Tessa in better blood glucose numbers can reverse the neuropathy.
     
    Last edited: Dec 2, 2018
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  5. Tanyacatz

    Tanyacatz New Member

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    Mar 11, 2016
    She already gets B12 injections monthly, which started weekly initially... and her front paw also folds over like she can't feel it. I just fear it's neuropathy from this HHS, and no idea whether that, along with her incontinence can improve. BGs have been all over the place for several years... Super highs, and then crashing... I truly believe that she has an underlying issue such as Cushing's or acromegaly which is keeping her BGs so high... unfortunately now she has this HHS, which is a critical illness (often fatal) for diabetics, from my understanding.
     
  6. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    @Wendy&Neko is one of our best for high dose conditions....
    @Marje and Gracie is good at deciphering lots of key information


    My first question for you is to look on your invoice or your bottle of b12 and see if it is labeled cobalamin. Cobalamin does nothing for neuropathy.

    What we are talking about for neuropathy is Methyl-Cobalamin. Zobaline is methyl-b12 . Click on the blue word and it will take you to the link.

    From what I was just reading of Hyperosmolar Syndrome. It is treatable.
    I think that means every thing could improve for Tessa.

    It sounds like you've found the right place for help in all of us here on FDMB.

    Do you test and monitor her glucose or have you just been relying on the vet?
    If you are willing to jump in with both feet, we can help you learn to test, keep track of her bg with a chart, and direct you to what tests you could get to find out if she has a high dose condition.
     
  7. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
  8. Tanyacatz

    Tanyacatz New Member

    Joined:
    Mar 11, 2016
    Thank you for the message... I am in Canada, and the B12 I got from the vet clinic just states I believe it's the brand name as Covidien, and the label just says vitamin B12 injection 5000 ug per ml.

    I have my own glucose meter and check Tessa's BG as needed, as well as doing glucose curves... but I am unfamiliar with what everyone talks about as nadir on here?

    Thanks again for the support... There seem to be so many knowledgeable people on here, so I am super thankful for that ❤
     
  9. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Nadir is the lowest point in the cycle, or between the shots. Take a read through the Sticky Notes at the top of this forum for some background. Take a look at the spreadsheets in other people’s signatures. For most you’ll see quite a bit of variability in blood sugar numbers throughout the day. With our dosing methods, we try to make sure our kitty’s are not hyping at their low points or nadirs.

    It’s likely the B12 you have is not methyl B12. A lot of people here use Zobaline, which unfortunately has a high shipping fee to Canada, which is where I live too. If you search for “Zobaline in Canada” on the main feline health forum, you will find some solutions others have found,
     
  10. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Hi and welcome to Lantus & Levemir Land, the nicest place you never wanted to be.

    It's great that you're testing at home. That is the best way to keep Tessa safe. It would really help us to know how to help you if you could set up a speadsheet and record all the BG numbers that you have on it. You would be amazed how much you can learn about how insulin is affecting your cat by looking at a spreadsheet. Here are the instructions for setting it up. If you need help, just ask.

    Also, we find it's best to pick a dose and stick to it for at least 6 cycles (unless kitty dips low). Lantus does best with consistent dosing, because of the depot. As Wendy recommended, it will help you to understand what's going on with Tessa if you read the stickies at the top of the L&L page. There's a lot of info there, and it can be very overwhelming, so ask lots of questions. There are many people her that love to help.

    Additionally, here is a post we put together to help people that are new to our forum. It's kind of like a Q&A.

    Don't give up on Tessa. You've found the right place to learn how to help her. :bighug:
     
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  11. Tanyacatz

    Tanyacatz New Member

    Joined:
    Mar 11, 2016
    Thank you, Wendy & Tricia... Tessa usually has been in the last few months anywhere between the high teens and high 20s, with a couple of low 30s... When I do glucose curves, she is always typically within 10 points of one way or the other, but has not been below 14 in months (which is also why I become paranoid and drop her dose when she is lower than 11, because she has also crashed twice in the last year)... she also doesn't follow the typical traits for diabetics, though, being as she jumps all over the place with her BG levels. The vet is even baffled by her condition, which is why I want to test for Cushing's, if there is going to be some light at the end of the tunnel... I have attached several photos of nearly this entire year of BG testing... please let me know your thoughts. I have been trying to help Tessa for four years now, and I really hope that this isn't the end for her ❤
     

    Attached Files:

  12. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Tanya, did you read any of the stickies? There is a phenomenon called bouncing, where the BG level drops and the body, having become accustomed to high BGs, panics and releases glycogen to bring the BG back up to what it thinks is normal. That is a very simplified explanation, but it's what can cause high numbers. If you run a curve when Tessa is in the middle of a bounce, all you will see is high numbers. If you could just set up the spreadsheet and enter the last couple of weeks of numbers into it at least, it will help us see what's going on. Be sure you use the spreadsheet that has a page for World numbers and one for US. We generally use the US numbers here, and that spreadsheet is set up so that it converts the World numbers you enter to US ones.

    I also recommend you order some Zobaline, if your finances allow. It can make a huge difference if Tessa is experiencing diabetic neuropathy. My Cinco had it really bad, and the Zobaline helped a great deal, although it does take time.

    Meanwhile, we need to get you to a dose you can give consistently, because changing doses frequently makes the depot unstable and will make the numbers much worse.
     
  13. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    Please let us know what the vet says tomorrow. There could be hope for Tessa, and we would be happy to assist in any way.
     
  14. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    you can also look for methylcobalamin such as this https://www.amazon.ca/Pure-Encapsul...4049&sr=8-1&keywords=methylcobalamin capsules

    you would want the dose to be at 3000 to 5000 mcg. Since this is a b vitamin, it is water soluble, the body only takes what it needs and pees out the rest.

    By the way, 5 units of insulin isn't a super high dose. There are some here on 20 + units.... who do have high dose conditions.
    The test is a simple one and not that expensive.

    From what I'm reading on this syndrome....
    it comes from not having the necessary insulin and dehydration over a long period of time .
    If you get a spreadsheet up for us, we can help you with the dosing so that you are more consistent. And if you decide to follow tight regulation.... which we would recommend if you have flexibility in testing and aren't away from home all day.

    I wouldn't give up yet. Just getting her better treatment will help with all of her issues.
     
  15. Tanyacatz

    Tanyacatz New Member

    Joined:
    Mar 11, 2016
    I am familiar with the symogyi rebound, which is why we opted to reduce her insulin to 4 units a couple of weeks ago to see what effects that would have... It did nothing. And now this morning she doesn't want to eat anything, so I'm not sure whether to give her her insulin or not... She was at 18.5 just now.
     
  16. Bellasmom

    Bellasmom Well-Known Member

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    Feb 12, 2018
    Ana & Frosty (GA) likes this.
  17. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

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    Jan 19, 2018
    Thanks. I responded to her post in another forum.
     
  18. Tanyacatz

    Tanyacatz New Member

    Joined:
    Mar 11, 2016
    My heart is broken, but I know my little girl is running free, and eating as much yogurt and playing in water as much as her little heart desires
    Tessa Henton 01/25/11 - 12/03/18 ❤
     
    Ana & Frosty (GA) likes this.
  19. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I'm so sorry you had to let her go. :(:rb_icon:cat_wings>o
     
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  20. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

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    Jan 19, 2018
    I am SO sorry. But you did the most kind and selfless thing there is to do for your fur baby. Although Frosty did well for some time, I think he suffered at the end, and I feel a lot of guilt about that. I have said many times that I wish I had let him go earlier. You did the right thing. Many hugs to you and wishes of comfort and peace. Your beautiful girl is no longer suffering. You are an amazing cat parent. ❤️:bighug:
     
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  21. Sharon14

    Sharon14 Well-Known Member

    Joined:
    Aug 16, 2015
    I’m so very sorry for you loss:bighug:
    Fly Free Sweet Tessa:rb_icon:
     
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  22. Bronx's dad

    Bronx's dad Well-Known Member

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    Nov 30, 2016
    I am so sorry for your loss.

    Fly free Tessa :rb_icon: 14572.jpg :rb_icon:
     
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  23. Tanyacatz

    Tanyacatz New Member

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    Mar 11, 2016
    Thank you, All ❤
     
  24. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    Jul 9, 2012
    I'm so sorry too. Prayers for your grieving heart. Fly Free Tessa...
    [​IMG]
     
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  25. Tanyacatz

    Tanyacatz New Member

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    Mar 11, 2016
    A couple last moments... Thank you all so very much, and blessings for your furkids ❤
     

    Attached Files:

  26. Sharon14

    Sharon14 Well-Known Member

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    Aug 16, 2015
  27. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    :bighug::bighug:
     
  28. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    I am very, very sorry you had to let your baby go but it is indicative of your love for her that you set her free. many prayers for your peace.
     
  29. Tricia Cinco(GA) & Harvey

    Tricia Cinco(GA) & Harvey Well-Known Member

    Joined:
    Jul 18, 2011
    {{{Tanya}}}

    I am so very sorry to hear that Tessa is at the Bridge. You loved her so much. She knew that, and trusted you to do what was best for her, no matter how much it hurt you. Remember, she isn't far away as she will always be in your heart.

    Fly free, Tessa, and land softly. :rb_icon:
     

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