Hypoglycemic Episode

My diabetic cat, Zachary who is 12 and was diagnosed with diabetes exactly one year ago, had a serious hypoglycemic episode last evening with an extreme seizure. I'm very sure it was partly because our vet recently advised us to increase from 1 unit to 3 units of Lantus and also give another unit between his usual 2 doses if his BG goes over 250 which we did just before the seizure. It was also partly because I read the BG monitor incorrectly and thought it was the very high reading that still showed up from a month ago when it actually had dropped to 26 last evening. I did 7 BG sticks in the past 24 hours starting with 26, increasing throughout the day and with a high of 407 just now at bedtime. We have refrained from giving him his usual dose of Lantus in the morning and just gave 1 unit with his bedtime meal. We're not sure if this is the best decision, how find the best dosage, and how to increase. Our vet has us using the Lantus pen and it can only b set for whole unit increments. I'm open to any help with this.

 

Hi Cathy and Zachary. Welcome to FDMB,

I'm so sorry you and Zachary had that experience last night. I can only imagine how frightening it must have been but you obviously handled the hypo situation very well!

It does not come as a surprise to me (and won't to anyone else either) that your vet raised Zachary's dose so much. I'm curious as to what data your vet used to make that significant a dose increase. Was this based on a curve done at the vet's office? Cats usually have increased BG numbers at the vet's office due to stress and this all to often leads the vet to prescribe too much insulin. Thankfully you are home testing because you saved Zachary's life last night as a result.

I have never heard of a vet recommending a third dose of Lantus and don't think your vet understands how Lantus works. There are other older insulins where this might be feasible, but Lantus is typically dosed twice daily, 12 hours apart at a consistent dose both AM and PM.

It's important to note that a hypoglycemic event can make a cat a little more sensitive to insulin. What kind of meter are you using? Pet meter or human?

Withholding this morning was the right thing to do. At a reading of 407 (either meter type) my feeling is that you are probably fine with the 1u tonight, however, given the extra dose yesterday and the hypo event, if I were you, I would get another reading at 2 hours or 3 hours after tonight's shot to see if Zachary is dropping and how quickly. Because Lantus is a depot insulin, shooting in the middle of a cycle means more overlap of doses and makes it far more difficult to predict when his lowest periods will occur and how low he might go.

We routinely use syringes here with 1/2 unit markings so we can make finer dose adjustments. I believe Walmart has Relion syringes which a lot of our members use. The pen refills can be used as vials with the syringes.

We have a spreadsheet available here and stored on Google docs that allows you to track Zachary's readings. The spreadsheet is also available for viewing by the members here who can help you figure out the right dose for Zachary and work toward getting him regulated. The instructions for the spreadsheet are HERE.

Should Zachary be dropping fast tonight and you need more assistance, you can put a prefix on your title with a "?" or a "911" if it is an emergency using the drop down selection box at the left of the title entry field.

Things are a little slower on the board right now due to the holidays so please forgive the delay. There are folks here from all over the planet so usually you can get some help fairly quickly especially if you make it apparent you urgently need assistance.

 

Welcome to FDMB.
So glad you made it through the hypo episode.
You can use U-100 syringes to take out insulin in other than full unit doses. Just take the needle cap off, look for the gray section on the cartridge, and insert the syringe in there to pull out the dose you need. (Do not inject air.)

 

Hi Cathy,

Just checking in to see how Zachary and yourself are doing. It would be great to hear from you. You've both been through a rough experience this week.


Mogs
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First, I want to welcome you and congratulate you on a job well done. I went through a week last summer when my cat was having hypo readings 2 and even 3 times a day so I know something about where you've been recently. It sounds like Zachary is a very lucky kitty because he has you to look after him.

There are lots of people here with a great depth of knowledge who will be glad to help you with your questions. I have found that the time I spent to set up a spreadsheet with my kitty's numbers was a very valuable investment. When experienced eyes look at the information there it is so much easier for them to help you with your questions. If you need help getting that set up, I'm sure there are those who can walk you through it. Please let us know what else we can do to help.

 

Thanks so much for checking in! Zachary is stable. Very active and playing with his Santa fishing pole toy a lot, ravenously hungry, eating a lot, and looking VERY underweight. His BG is in the upper 300's but stable. Tomorrow I will buy him syringes so I can increase his insulin by smaller increments then the lantus pen. I'm thinking I should increase from 1 unit to 1.25 and see how his BG does for a few days. I'm predicting that we get to and stay on 1.5 or 1.75 eventually. I did set up a spreadsheet and set it to be shared for anyone. It's titled "Zachary's Spreadsheet" and it'a under towardtheone2007@gmail.com. I hope I did that correctly.

 

Thanks so much! I did set up a spreadsheet and set it to be shared. It's titled "Zachary's Spreadsheet" and it's under towardtheone2007@gmail.com. I'm very open to help with regulating his BG and insulin. Zachary is such a sweet boy. He and his brother and sister have been a part of our family since he was a few days old and found with worbals under his skin and taken from his feral mother. We got him through that and I bottle fed them so they are especially affectionate and think I'm their mom. All help with sweet Zachary is very appreciated!

 

If you look at my signature at the end of my posts you will see "Radar's Spreadsheet" If you click on that then you can look at his numbers. In the upper right hand corner at the top there's a place where it should say your screen name - Cathy Palmer - If you hover your mouse there it should show a drop down box with several things. One of them is signature. If you click on that you will be able to write your signature kind of like what I did with some basic information that will show on each post you do on the FDMB. Here are the directions for making the spreadsheet and at the bottom are the directions for putting it in your signature so we can all see it. http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ I hope this makes sense to you. Let us know if you are having challenges with this and someone will be happy to help you fix it.

It sounds like your Zachary's personality is like my Radar's. He also was a rescue and I think that's made him especially sweet. Let us know what else we can do to help you and Zachary.

 

Hi Cathy,

I'm relieved and very pleased to hear from you, and delighted to read that Zachary's back to his playful self. Thank you for sharing a little of his story. It's wonderful that you were able to save Zachary and his brother and sister. It sounds like you - deservedly - have an extremely close and special relationship with Zachary and your other fur babies.

Good news on the syringes. Dose adjustments are most commonly done in 0.25 unit increments. The syringes will be a great help to you in fine tuning Zachary's insulin doses. There are a number of very experienced people in the Lantus and Levemir insulin support group here that can help with dosing reviews. Word of caution: after a symptomatic hypo some cats can become much more sensitive to insulin. If you post asking for input on dose adjustments I'd recommend that you include a note in your post advising readers that Zachary has had a serious hypoglycaemic episode with severe clinical signs. It should be taken very much into consideration by people replying to posts on dosing. Also be sure to mention that Zachary needs to gain weight. They should be able to provide valuable input on a suitable feeding and dosing strategy for your precious boy.


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