Hypo twice in 1 week....taking an insulin break

Hello Everyone-

Disclaimer: I apologize in advance for how long this post is. I wanted to be thorough....

Harley was diagnosed almost 2 years ago. She was initially being monitored by my vet with monthly glucose tests, but last fall, my vet closed up shop. A little background....the vet put her on M/D dry food (which I always questions, and was always brushed off) and we started with 1 unit of Vetsulin, once a day. Over the course of a year, she worked her way up to 4 units, twice a day. In November of last year, I came home to find her severely hypoglycemic and rushed her to the emergency hospital. After an overnight stay, she came home, with a decreased dosage of 1 unit twice a day....vet recommended I stay on the Vetsulin. After a couple of follow-up checks, he increased her dosage to 2.5 units twice a day and finally switched her to Lantus. I used the Lantus for the next 3 months...with no trips to the vet for blood glucose tests or home-testing.

Please don't criticize....I know it was risky to take this on by myself, but I felt that I had a pretty good handle on her dosage, and until I majorly messed up, feel pretty confident that I did. What's happened recently is a result of ME changing her insulin (the Lantus was so expensive, I opted for Humulin N) and again, gradually (and I mean gradually) changing her dosage based on her behavior....I have also changed her from the dry food diet to high protein wet food....everyone can breathe a sigh of relief now....I am home testing.

I have been searching the internet for information on weaning a cat off of insulin, or if that's not the right word, how to determine if her levels are 'normal enough' off of insulin to warrant a major change. As the title of my post reads...she's been hypo twice in the last week....once, completely my fault, and the other on what I considered to be a relatively low dose. OK. Here's our recent ongoings (last month or so)...

When I switched her to Humulin, I reduced her dosage from the 2.5 to 1 unit twice a day (I would rather under dose her than over dose her). She seemed to be doing fine, but after a couple of weeks, I noticed that she was drinking more and urinating a lot. I gradually moved her up (.5 at a time) from 1 to 2 units twice a day. Enter diet change. Unfortunately, it was a busy morning, I honestly did not think I had given her a shot (I broke my routine which is my safeguard for tracking...MY FAULT). I double dosed her within about an hour or two of each other. So she essentially got 4 units that morning. I came home 8 hours later to find her staggering around. I immediately gave her syrup and fed her a can and a half of food. Two hours later, after several calls to the emergency vet, a touch more food and probably a total of 2-3 tsp of syrup, she was still not coming back. I took her to the emergency hospital....her blood glucose was just over 300....no more hypo, thank you, maple syrup. I skipped her next shot (of course) and the next day, dropped her to 1.5 units twice a day. Things seemed to be fine for about a week, but yesterday, I came home to find her staggering around again....same symptoms (12 hours after a 1.5 shot). Again, I gave her a small amount of syrup (much less this time, and yes, I know I need to get Karo) and fed her a can of food. She rebounded fairly quickly this time. Pfewf!

So LONG story short (sorry!), I purchased a kit to test at home. There is no way she should have been hypo 12 hours later from 1.5 of Humulin...it's so short acting, right?). Which led me to wonder if she was regulated with the diet change, and ANY insulin was too much insulin.

The testing was a nightmare....a dozen strips later for the first successful test....her BG tests yesterday and today are as follows:
6/21 - 10pm = 271 (no shot given) (post food/syrup due to hypo)
6/22 - 8am = 263 (no shot given) (pre-food test, then food delivered)
6/22 - 11:30am = 269 At 9:30pm,
6/22 - 9:30pm = 296 (pre-food test, then food delivered)
6/22 - 10:30pm = 266

Ok. What are your thoughts on those numbers....taking into consideration the recent happenings?? She's been insulin free for more than 36 hours. I know they are elevated, but are they crazy elevated for not having a shot for so long? Are there any modifications I can make to her food delivery to help regulate her a bit more? She was hypo on such a low dose...I'm really nervous. I work 20 miles away and am typically gone for a good 11-12 hours. Please don't judge me too harshly....and please send me your thoughts or suggestions. I look forward to hearing them! Thanks, everyone!

Sherry and Harley

 

You have had a rough week, haven't you? I am so sorry {{{{{HUGZ}}}}}

Since you are seeing those numbers, sans insulin, I am thinking it is entirely possible that your baby may be ready to go off of insulin with a diet change to low carb content foods. The numbers are not horrible, but they are diabetic numbers which require insulin....

You can get many low carb content canned foods at just about any store and they are much less expensive than, and much better foods, than 99.99% of the veterinary RX foods, (such as DM), out there.. I am going to suggest Fancy Feast, Friskies, Special Kitty, WalMart brand), or Sophisticat, (PetsMart brand), to start.

Please read over the links below and choose foods that are well under 10% in carbohydrate content.
Personally, I would choose foods no higher than 5% if you are going for straight diet control.
http://binkyspage.tripod.com/CanFoodNew.html
http://binkyspage.tripod.com/CanFoodOld.html
http://www.felinediabetes.com/glutenfree.htm


One thing that I would like to point out - your baby may still need insulin, but, maybe a micro dose such as .25, or .50 of a unit BID even with a diet change to low carb canned foods. You are not going to know that, however, until you change the diet and then home test - and I do mean home testing regularly at least in the morning and again in the evening when you would normally give a shot and then again, about 6 hours post shot....

If this were my cat I'd run to the nearest store and get some low carb content canned food and starting tomorrow morning, feed ONLY low carb food from now on, and home test every single day. I would also go back to Lantus if my cat were in need of insulin - even micro doses.

I am sure that other folk will be along to give you more advice shortly. I am off to bed!

~M

 

Hi-

Thanks so much for your response. I'm sorry....I was trying to make sure that I gave everyone all the information, but in looking back, the food change was not clearly explained. I did change her diet, just prior to the first of the last 2 hypo episodes (maybe 1st week in June?). She's been on 3 cans of Fancy Feast, which she gobbles up like it's kitty crack! I give her a can in the morning before I give the shot (when I was giving shots) and then a half a can before I leave the house. Then I give her the other half when I walk in the door and another can pre-shot just a tiny bit later (or vice versa - but she gets a can and a half twice a day). She's a bit tubby, so I'm trying to watch her waist for her! Although, pre-diabetes, she weighed nearly 19 pounds. She's been at about 15 pounds for the past year and at the emergency vet last week she was 14 pounds....of note, the vet was not happy to hear that I was feeding her FF because of the fat content. I don't have a lot of faith in vets, which is a topic for another day, so FF is still in the bowl!

Off the insulin, I'm not noticing any increase in water consumption, and her litter box looks pretty normal (i.e., no excessive peeing). For a little extra background info, when she was diagnosed 2 years ago, and during subsequent BG tests as her initial dosages were being adjusted, her BG levels were in the 400 and 500s....on insulin....she just seems so different now, which is why I'm reaching out here. And yes, I've already resigned myself to switching back to Lantus....I'm on a budget, which is why I made the change last time....to hell with the budget, I'd rather she be ok!

Again, thank you for listening and lending your thoughts. Cheers!

Sherry and Harley

 

if she did hypo, those may be the tail end of some rebound from the earlier lows but those may just be her regular readings if it's been over 36 hours.

why don't you post on the Lantus forum to get a starting dose?
with numbers in the 200s i wouldn't let her go without insulin. we don't want her to end up in DKA from untreated diabetes.

do you have lantus right now? if so how about trying 0.75u and seeing how she does on that? (others will weigh in, i'm sure, and may have other ideas about a starting dose.)

humulin hits many cats a little too hard. if you can follow the tilly protocol for lantus/levemir, lantus is known for flatter curves and may be gentler for her. but you have to be pretty stable about dosing, meaning doses should be tried for at least 3 days before increasing, and only by a small increment and depending on nadir and preshot test. if the readings drop below 40 we reduce the dose by 0.25u immediately (no need to wait to reduce but don't want to dose hop in terms of trying different doses). please take a look at the announcements at the top of the lantus forum page, particularly for information on the tilly protocol and information for newbies.

particularly because you've seen some pretty big hypos recently, i can't stress enough how important it is to home test. don't worry about the past. the past is the past. let's just concentrate on the present and make sure to home test from now on. even people who have been doing this a very long time can't really tell from behavior how the numbers will turn out. it's very important to keep testing.

glad that you've switched to low carb fancy feast. there is something to be said for sticking to a lower fat content, which you can still do with different fancy feast varieties. lots of our cats do very well on fancy feast, including my cleo.

 

Your vet might be worried about the high fat, not understanding that it is low carb. If you lower the carb%, then your fat and protein % are going to go up. Not all vets are dieticians. In most cat foods, a high fat % often indicates low quality food. In a healthy cat, if you wanted them to lose weight, then you would want a high protein, low fat food. But again, you lower the fat %, you are going to raise the carb %. I would discuss your vet's concerns about the food. And then ask about those concerns here. And be sure to look at the recommended food list from Dr. Lynne.

 

Ok. Well....the honeymoon is over. She tested at 341 this morning. I fed her and gave her .5 units....treading slowly. +1 her BG was 298. I have to go to work, so I won't be able to test again until 6pm or so.

Unfortunately, I have to use the Humulin N until I get paid. It is my intention to switch back to the Lantus, I just can't do it at this very moment. Does anyone have any super secret tricks to finding cheaper Lantus? Of course, I will do whatever it takes, but I figure you all would know if there's a place I can get it that's more cost friendly. In my heart, I'll spare no costs for her, but the bank account says what the bank account says. :-(

As a side note, stabbing her little ears so frequently is breaking my heart. She twitches her ears and shakes her head a lot (in between testing), which leads me to believe that it's bothering her. Another sadface....

Thank you for all your help.

Sherry and Harley

 

I know this won't mean much to you, but Tucker sometimes sleeps through his blood tests. I know he does not feel the lancet at all because he doesn't wake up. Maybe Harley is just getting used to you doing stuff to his ears.

I've had a few diabetics and none of them ever really cared about the blood test, but part of that is because I'm not nervous or upset when I do it, the more experience you get the more comfortable you will feel, but please do feel comfortable knowing that by doing the blood test you can and will avoid hypos and other serious situations going forward.

 

Sherry,

How were you getting the Lantus, a vial or cartridges? Cartridges are more expensive up front, but the box of five should last you 6 months with proper care.

Can you tell us where you are located (general like city and state)? I might be able to help with a vial of Lantus. PM me and we'll see if we can arrange it.

Claudia

 

Good Evening-

Well....good morning actually. I'm not sure if those of you who responded will still be following this post (I'm not really sure how things work here), but if so, I wanted to let you know that I did a bunch of testing this evening to get a curve....pretty sure I did it correctly. Anyhow, I've graphed and attached her data if anyone wants to chime in. Started her this morning with .5 because I was nervous about leaving her for 12 hours and there being another issue. All was good when I got home. I gave her 1 unit for the evening shot and will be sticking with that for the next week or so (unless something terrible happens). The data are there if you want to take a look. Cheers!

s

 

Don't feel bad. For the first time that Blackie was diagnosed with diabetes in March, this past Tuesday was my first (and hopefully my last) hypo episode with her. It was scary. I even had a monitor and was just learning how to hometest. Her BG went as low as 21. I watched her, and noticed her staggering. Got on the phone Mary, another board member whom I recently had come over to help with hometesting her, and she talked me through it. Got her levels up to a more respectable #. I told my husband that had I not had that monitor, I wouldn't know what I was dealing with, or how to treat her. That night, though, I dropped her insulin to 1 unit, and fed her a can of FF. The next day, she started out at a higher #, but it was due to the carbs that the vet had put her on. She was eating the Hill's Prescription W/D dry for a bit, until last Saturday, when I told her taht I wanted to put Blackie on a wet food diet. I said low carb, but she wanted to feed her the Hill's Prescription W/D (again, another high carb food). I told her that we'd try it for a week, then I'd like to switch foods entirely to the FF. Saturday night was fine, all day Sunday was fine, Monday was fine, and bang! Tuesday mornig started out well enough at 140. Her BG went to 220 at +2, and dropped to 36 at +5, and again down to 21. That's when I was on the phone with Mary, whom helped me through the crisis. Her BG started going back up to 41 at 2:45 after I had given her a very small amount of honey, 1 tsp of the high carb crap, and 5 W/D kibbles. At 3:10, her BG was 77. 4:10 it was 159. At 5:50, it was 388. At 6:27 that night, BG was 430, and I gave her 1 1/2 cans of FF, and dropped her dosage to only 1 unit. At 9:30 that night, BG was 330. The next morning, I woke up to her BG being at 341. Wednesday all day was more or less a false reading day as her body still had carbs in it. Mary told me that the next day (Thursday), the readings would be a bit better. They are. I'm posting as each test is taken. Hopefully, I can get in a couple more readings tonight before I go to bed. She's very iffy about her ears being poked now since I've been doing it so many times. I hate it, but it's necessary. And she meows when it pokes her. Poor little love.

Eventually, I may put her on the Lantus, too. We'll see how things go.