Hypoglycemia

I have a situation here. I have been giving my cat 2 units of Vetsulin when he is over 200. On Saturday and Sunday I had episodes where his bloodsugar plumetted after doing so. On Easter, I had to stay home with him because it was dangerous. Went to vet on Monday and showed his numbers. Vet asked if the bottle was low and I said it was. He thought it was that since this just started happening. I bought a new bottle. At 8:34 PM tonight, he was at 294. I gave him 2 units out of the new bottle. It is not even three hours later, 11:11 PM CST and he is at 39! I gave Karo, and wet food with some high carb dry mixed in. I usually feed him Wellness wet chicken and turkey (very low carbs) and free feed EVO Cat and Kitten dry. I feed some stray cats Purina One and Pro Plan, and since that is higher in carbs, I gave him that but not sure if that is going to get me out of trouble with him since the insulin still has a couple hours before it peaks.

 

I don't know anything about the insulin you are on and am rather a newbie, but DRY is NOT what you want to feed. Do you have any High Carb wet food.
Primarily I've seen folks use the fancy feast grilled with GRAVY flavors. GRAVY is the most important part. You can drizzle just a little..on some wet food. OR have them eat a couple teaspoonfuls straight. The karo as I understand is quick, but not long lasting.
[url=http://binkyspage.tripod.com/canfood.html]http://binkyspage.tripod.com/canfood.html[/url] Here is the Janet/Binky list- you want to look for any canned OVER about 18 carbs. THE ones with GRAVY particularly. The cats will eat them and it won't take much. That way you can bring them up with very small amounts so in case you have to do it several different times they would still eat and not be stuffed.

It is 911 night tonight.

let me see who else is around with more experience. i am rather new and not the best help.

 

Just checked him and he is at 73, so I'm doing okay for now, but still have three hours of insulin to deal with. I am hoping the number goes up. Does anyone know how long it takes for the food to raise it? Hoping it will go a bit higher.

 

I thought I didn't have high carb wet, but I remembered a pet store gave me some free cans so I will see what they are and if he will eat more.

 

Can you catch another test in 30min to see if you are still rising? I think their usual recommendation is to catch a few tests to see that you are on the rise or at least surfing the good numbers for a little while.


eta: Are you aware of the instability warnings on Vetsulin from December? There is a post on it in the Vetsulin ISG Forum. Did your vet talk to you about the risks that posed for your kitty?

 

I also posted this on the Lantus Board, perhaps someone there can help you. I'm just not an expert...

 

I am NOT an expert. We have done this only a couple times. But I gave him the gravy off fancy feast on top of his LC food..and he scarfed it down.
There are sevaral on our board who will guide their cycle using it in really low numbers..but we are on Lantus and it is much longer lasting and mild. I am simply uninformed about the insulin you are on and how it behaves.
I think I waited and tested in a couple hours and his BG was up 12-15 pts or so. But he wasn't low low to begin with. You know your cat best, if you are really concerned, i would feed some of the HC WET food (NO DRY) and test again in 20 minutes or so. If the food you have has any gravy or sauce, pour that directly out for him...that is where the CARBS are most concentrated and you will get the most mileage.
If he is at 73, you could perhaps test like every 30-45 minutes until you are out of the danger window. But again, i have NO idea how that insulin works...you know best how your cat behaves on it.

What's the name of your cat food sample?

 

do you know when your nadir is ? ( peek insulin action? ) you need to keep testing until you are past that and you get confirmed climbing numbers.

and Please no shot in the am. If this has been happening several times lately, sounds like he needs a dose adjustment.

and as someone mentioned, please talk to your vet about the manu problems with vetsulin.

for now. make sure to breathe and get another test.

karo will spike up and then wear off fast. it is good you got some regular food into him too.
the high carb canned is best. don't get him too full though in case he starts dropping and you need to feed him more, ok?

 

Be sure if you are feeding the HC food to parcel it out so he doesn't get so full he won't eat again if you need to repeat further into the cycle.

That's why the gravy is great if you have it, lots of bang in a small amount. If not, give the HC food you do have by spoonfuls. then you can repeat in 1/2 hour or hour if need be at next test. You want to be sure he'll eat later if need be.

 

All sounds good. High carb wet food I have is Innova Flex - Kitten Chicken and Brown Rice Stew. I looked at Janet and Binkys chart and they have Natura Innova Chicken and Brown rice at 14% carbs. Not sure if that is high enough or if I should run out and get something else. The Wellness I have is only 5. He woofed down the high carb dry and that seemed to help alot.

Just checked him and he is at 74 and we are 3 1/2 hours into insulin and it peaks at 5-6. He has Karo syrup all over him so I'm going to use this safe time to clean him up and then check him every 30.

 

sounds like a great plan. and maybe put on some for you . going to be a long night.
will be up to check your numbers with you and I'm sure others will be around too so you are not alone !
are you going to be ok to stay awake?

usually 18% is considered hc ( the FF grilled flavors were always what I used. )
but the 14% should be fine. --- as long as it is something he likes

 

The dry takes forever to get him and another forever to get out of him.
I just checked the charts and don't see that particular food. Do see a chicken/brown rice version (not the kitten stew variety) but at 14 carbs, that would only be considered Medium carb.
The fact that it's called 'stew' may indicate other ingredients. Ultimately it would just be a guess since that exact variety is not on the charts.
Kitten foods tend to have a higher protein content, and lower carb. if in a bind, you could drizzle syrup on that and mix it in.

If you have other 'safe' time, I would still recommend the fancy feast grilled, roasted, ANY of those with the gravy. Even Walgreens/CVS carry them, though they will cost a little more there. But it's an option in an emergency if it's open or closer.
If you test and the number is trending upward you may not need it. However for comfort zone, i'd want to have it in case. It is going to carry him the furthest. ..and moreso than the Karo.

BTW, i too feed natural foods for their day to day. But it was drilled into me on our Lantus forum to put a hypo kit together with the fancy feast, some of the 9-lives, etc.. and sure enough, it was a matter of days before I had to reach for it.
It's not going to be a staple so It's ok...you're only using it like medicine.

 

for future reference ( and something to read while you are traveling the lowlands )
here is jojo's hypo toolbox :

viewtopic.php?f=14&t=2354

 

I wouldn't worry so much about the dry food. The only issue with using it when numbers are low is that it takes a while for it to get into the system and a while for it to work its way out. The wet food works much more quickly.

If your cat is responding to a 14% food, and there's no reason to think that this won't work just fine now that numbers are up, you can feed it in small amounts to keep numbers bumped up. You should get at least 2 consecutive tests in a 20 -30 min. window (I'd lean toward 20 min.) where numbers are surfing or rising. You can then space out the tests to about an hour apart. Then the same idea -- two test where numbers are stable or rising. With a very low number, there's a chance you may see numbers rise then drop again.

Like Cheryl asked, do you know when you typically get your lowest number in the cycle? I'm more experienced with Lantus and the insulin you are using is a shorter duration than what I use.

 

Going down - he's at 60 now. Time on meter is 12:43 CST. Its about 5 minutes off. It was really about 12:38 AM. He just scarfed down a good bit of the higher carb wet food so I will test him at about 1:15 and see how he is. I am a night owl so 2 AM is early for me. Especially since I have been laid off. I've been staying up until like 3 and 4 AM looking for jobs.

 

how much is good bit? just remember only let him have a spoonful or 2 at a time of hcc food between tests--
you don't want him full .
( does he usu have a good appy ?)
gee I looked back and didn't see his name posted -- will you let us know?

will look for your next number. you're doing great !

 

I don't really know when I get the lowest number in the cycle, but based on what I went through over the weekend, its between 5-6 hours. Its hard to tell because the only time I have tested that much was when he was very low and I had to get him back up by feeding him the Karo and high carb food.

 

Hi there,
your plan sounds just fine, don't worry about having used dry food, I successfully treated a dry food addict and got him OTJ (in hypo situations I had to use dry because it was all he would eat and combine it with honey for the quick action).

For the long term, it is clear that 2U is too much insulin especially with preshots in the 200's Vetsulin is not given like Lantus and dosage is based upon both preshot and nadir numbers. i ALSO SUSPECT THAT YOUR CAT IS POSSIBLY NEARING REMISSION (sorry caps lock ohmygod_smile ) What you are seeing with those higher preshots is a case of rebound. You have a preshot of 200 and shot 2U which is dropping him below 60 quite quickly and his liver is going into protective mode and dumping sugar to counter the low plus you then need to feed higher carb to raise the numbers which leads to another higher preshot 12 hours later.

I suggest at your next preshot (which may be quite high after this hypo) you either skip the shot entirely and continue to measure BG throught the day to see if and how much it rises. If he is possibly maintaining his own BG levels you may see the numbers decrease even without insulin.

If without insulin for 1 day you continue to measure numbers higher than 150 then you need to give insulin but much less than 2U, perhaps start with 1/2 unit (0.5U) and see what that gives you for numbers. If you don't get better regulation or discover that he going into remission, then I would suggest trying to switch to a longer acting insulin like Lantus.

Vetsulin rarely lasts longer than 10 hours and the chances for a very low BG after 5 hours is slim so once you have passed the 6 hours post shot there is no need to feed HC and don't worry about numbers higher than 50-60, those are normal numbers for a non-diabetic or a cat in remission and I suspect that he will perhaps stay in the 50 to 150 range without insulin.

 

Bwt 5 &6 hrs gives a good idea. for treating this hypo error on side of caution and say it is at +6, sound good?

Data collection is so important to treating FD.
You get to know your cat better --- when the nadir is. are they early or late droppers ? stuff like that. and it helps to determine and continue to monitor the dose.
you can tell by funky numbers if something else might be going on. ie: sudden high number might mean and infection ... maybe a dental is needed. or something simple like a fur shot. sudden lower numbers can mean you have some healing of the pancreas and it's time to lower the dose. or maybe you accidently shot the wrong dose ( yep happens w/ not quite awake eyes sometimes)
of course, some are limited by work hours. but still on weekends mini curves now and then and spot checks every day when you can a good idea. you do the best you can.

Have you thought about setting up a spreadsheet? a great way to see patterns in your cat's BG numbers and also help others ( on board and your vet) look at your cat's numbers -- makes it easier for them to share their experiences to help you understand what is going on w/ your kitty.

 

2:03 and he is at 62! I think we may be okay. Gonna check again around 2:30.

 

I agree with Monique. Since he may still have overlap in him. Definitely shoot a lower dose. We can all help you, but making a SS would be key for us. You're doing a great job. I'd keep testing since the dry food etc will raise his BG, but then like you saw.. it drops again. Hang in there. Sending you good vibes!

 

fantastic no more drop, he's holding his own-- 62 is flat from his last test ( those 2 points don't count as a rise :smile: ) remember you need 2 tests past nadir that are rising before you can call it a night , k?
If I calculated correctly your +6 will be at 330ish?

i"m up so I'll be back to look for you next tests.
you guys are doing great !

 

+6 is at 2:30 CST, so 3:30 EST. What is nadir? And what is SS? Sorry, I had him going so good for so long, these worries are all new to me. Next time he is over 200 I am only going to give him 1 unit. I'm calling the vet tomorrow as well and I'm sure he will agree. Not sure why he is going so low when I give him 2 units when he is so high.

 

2:30 and he was at 61. I feel safe now. He has high thyroid numbers too so not sure how that plays into the diabetes if at all. I'm going to ask the vet tomorrow. I was supposed to be giving him 1/2 pill for his thryoid (Tapazole) twice a day. I've mastered the blood testing and insulin shots, but the pills are much harder. I thought I was doing okay but then found several of them on the floor. I had thought he took them but I guess he was spitting them out. So I was trying to hold his mouth shut longer, but that just let to him bunny kicking me and lots of scratches. So the vet is going to call in the salve that I will rub on his ear instead. He is almost 17. His dog buddy he grew up with died two weeks ago - my rat terrier Spotty. They were pretty much best friends. I know he doesn't have a long time left.

 

nadir:

The lowest point on a BG curve, often considered the same as the peak insulin reading.

from http://felinediabetes.com/dictionary/ca ... ry-3.htm#N

And what is SS?
spread sheet. if you at many members signature line you will see a link for a ss. click on one and you will see what they are like and how they can help. alas -- I don't have one. My Winnie is GA ( gone ahead or guardian angel ) from non diabetes cause.

Sorry, I had him going so good for so long, these worries are all new to me.



I know it is very overwhelming. everyone here was once new at this and has gone through the same thing one way or another.

Next time he is over 200 I am only going to give him 1 unit. I'm calling the vet tomorrow as well and I'm sure he will agree. Not sure why he is going so low when I give him 2 units when he is so high.

First a disclosure: I was a lantus user and it is dosed on nadir not preshot. a little different.
I do think you need to lower the dose no matter what you get for preshot. ( yes your kitty may get a bounce )
since you do not have much data -- you don't know what action the insulin has been having on him except for these cycles of lowlands. I am guessing since this is not the first time he has gone low recently that perhaps he is vacillating between hypos and rebound. not good. If it were my cat I would either shoot a much lower dose or, as I suggested earlier, skip shot tomorrow and call your vet.

also if you can put up a ss or just post some numbers until you can get a ss done, it would really help others to see what is going on w/ your cat. and don't forget those inbetween checks. +2 +4 +6 +8 +10 good start for a mini curve. you don't have do it all the same cycle.


eta quotes ed typos ( i tried. i give up)

 

he is staying flat. but he could still drop. you are just at your nadir. -- or your best guess at what your nadir is since you do not have a lot of data.
please try and get 2 rising numbers before you stop testing to be safe.

I'm glad you will be in touch w/ your vet tomorrow.


I'm very sorry you and your kitty lost your dear terrier friend. That's very hard and painful for both of you to lose such an old and much loved friend.

 

3:15 AM CST and he is at 82! I'll be going to bed soon. Thanks everyone!

 

Nadir is the term for the time when the blood glucose is at it's lowest point (or the other way around it is when the insulin is working at it's strongest)

SS=Spreadsheet, most of us here use a Google spreadsheet template to record our measurements. The instructions and link to setting up a SS and a Google account can be found on the Tech forum. The Spreadsheet gives you and those helping you a nice overview of your collected data. Because we are all in different time zones we don't report based on local time (ie. 2:30 PM) we use a system which everyone can follow

AMPS is the morning BG measurement (AM=morning) PS= Preshot that you measure just before injecting insulin
+1 is one hour after you gave the shot
+2 is 2 hours post shot
+3 and so on.....
+11
then the 12 hour becomes PMPS (PM=evening PS=preshot) and the +1, +2 starts over again for the evening cycle (cycle is the 12 hour periods at which insulin is given)

If you look in my signature below you will see a link to "Spooky Caninsulin" click on it and it will take you to our SS when we were using Caninsulin (Caninsulin is the European name for Vetsulin)

You mention you were giving 2U on Preshots of 200-300, those are not considered really high numbers, every cat is different and some cats are more sensitive to insulin than others. Many cats would drop to low on less than 1U of insulin with a preshot of 300, others might need 3U to drop below 100 from a Preshot of 300. Because each cat responds differently it is important to start at a low dose and make small increases/decreases based on the results you get from regular measurements. Based on measurements you can dtermine the "amount the BG drops per unit of insulin" which is different for each cat. If I take a given day from my SS and calculate
AMPS 450 Dose 2U +4=95 +5=96 +7=184 PMPS (+12)=479

450 is my starting number and at +4 (95) is my lowest number=Nadir the difference is then 355, meaning that 2U of insulin lowered his BG by 355 points

355 divided by 2U is 177, so each unit of insulin lowered BG by 177 points. This may not be the same everyday but if I were to have a Preshot the following day of 250 I would be worried about giving 2U again because I can't have a drop of over 300 when he is at 200 to start! I might consider 1U which would lower him theoretically 177 points, giving us a nadir around 73 which would be considered good.

You can see from my SS that I was giving 2U but my preshots were often over 400 and I was testing daily several times and not getting numbers below 200 most of the time.

As I suggested, I think 2U is too much and possibly 1U could be too much. In the morning I don't know what you will measure for a BG, it may be somewhat higher (>200) because of the natural response of the cats body to the low numbers you are experiencing now. This is called rebound, then liver releases stored glucose (called glucagon) and other hormones (catacholomine, cortison...) to rescue the body from hypoglycemia and raise the BG. The effects of this can last hours or even more than 1-2 days. When you react to these higher numbers by giving another too large dose of insulin you perpetuate the cycle by dropping the BG to low again and causing the liver to panic and release more glucose and hormones, a never ending roller coaster ride!

To avoid this I think you should regaurdless of the morning preshot number skip giving insulin entirely for 1 day. Be sure and measure the BG several time during the day to see if the numbers go lower on thier own (which would mean the hormones from the liver are going away and the cat is producing some of his own insulin to lower the BG)

An example of what I might expect to see:

9:00AM AMPS 280- no insulin given

12:00PM (+3) 200

4:00PM (+7) 145

If your cat is under 150 at shot time I would not give any insulin. If he stays under 120 most of the time without insulin I would consider him going into remission (OTJ is our term for off the juice=off insulin, or Honeymoon) If he measures over 150 (200's) after 12 to 24 hours without insulin I would begin by giving him 0.5U and testing to see where that brings him down to in the 5-7 hours after the shot. If the 0.5U gets him close to 80-100 range then the dose is good, if he remains over 150 during the cycle I would then give a dose of slightly less than 1U (a hairs width under the 1U mark on your syringe). You can then keep fine tuning the dose this way. If you continue to have higher numbers at preshot but no hypo episodes then I would look into switching to another insulin type (ie. Lantus).

 

Thanks for all of the information. I had started off with 1 unit on him before and we had gradually increased. Then all of a sudden this started happening.

 

ETA Re: Hypoglycemia

he's had a nice rise -- great job !

ETA: Did you get your second rising number? always good to get the confirmation to be sure !

please edit your first header to take out the 911 -- since there is no longer an emergency.
Thanks !

Please let us know what happens w/ the vet tomorrow and what you decide to do.
Would love to see a ss and more data collecting ! :smile:

hope you get some sleep .

 

That is a sign that his pancreas is perhaps healing and beginning to work on it's own producing some insulin, therefore his need for injected insulin decreases.

When I began treating my cat my vet started him on Caninsulin at 0.5U which was not enough so we slowly inscreased up to 2.8U, I thought once we reached an "optimal dose" which gave us good nadir numbers he would continue on that dose forever.....I was wrong, and he went hypo several times so I had to reduce the dose eventually going back down to 1U, but he still wasn't fully healed (although I suspect he was at that point producing some insulin on his own) he would still have higher preshots, the problem was that first of all he was a dry food addict and I had a year long battle to get him switched to canned food (his dry food was over 28% carbs!) and second Canisulin just didn't last long enough to keep his BG in the "healing range". High BG (hyperglycemia) is not only damaging to organs like the nerves and kidneys it actually makes the diabetes worse and more chronic because glucose continues to damage the cells in the pancreas which produce insulin. In addition any remaining functioning cells (called ß-cells) will work in overdrive trying to fight the high BG and eventually wear out leaving less and less functioning ones and eventually permently distroying the pancreas which means the diabetes is chronic and remission is no longer possible. By keeping the BG in a lower range (generally under 150) as many hours as possible each day the damage from high BG to the cells is reduced and the still healthy cells are allowed to rest and repair so eventually enough of them are working and healthy that the cat can produce enough insulin on it's own to regulate it's BG while eating a low carb diet.

Insulins like Lantus and Levemir last longer and make it easier to keep the numbers in that healing range for 8 or more hours each cycle (16+ hours each day) which is enough time to allow a lot of healing in the pancreas. 85% of newly diagnosed cats (cats that are 6 months or less diabetic) acheive remission after being treated with Lantus and Levemir.

I switched to Levemir and after several months of keeping his BG lower most of the time (I was also during that time able to get him started on eating some canned foods and less dry) he eventually did acheive remission, since then I have successfully gotten him completely off dry food and he is now 8 months insulin-free.

I have no personal experience with hyperthyroid but I have heard that it does have an effect on BG levels. Given that your Preshots are less than 300, I suspect that your cat is in remission from the diabetes (or close to it) and these higher numbers are simply due to the effects of hypo and the associated rebound (liver reaction) coupled with the overactive thyroid.

Pilling a cat is not easy, if you have a look around Dr. Lisa's site http://catinfo.org/ there should be some info on pilling cats and some tips & tricks. You could also use the search here one board to find information on "pilling" and "hyperT" or "hyperthyroid".