Hypoglycemic Episode

Hello. We just began treating our diabetic cat with insulin starting on 8/17/16 (when he was hospitalized for a few days). We began administering it at home starting on 8/21/16.

This morning, we had a hypoglycemic episode. Malakai's blood sugar level was at 34. He lost control of his bowels, vomited about three times, and began to have seizures. I rubbed the Karo syrup on his gums and called the emergency vet. We got him into the vet within a half hour (running through red lights, speeding, squealing tires, and all). Once there, they catheterized him and began him on some sort of IV fluids. They said that he stopped seizing. They're going to keep him hospitalized overnight, and it's going to cost me around $2,000.00.

So...my questions are as follows...

1. Why the catheter?
2. Are there long-term effects of this hypoglycemic incident?
3. Most importantly, how can I forgive myself for almost killing him? I keep having flashbacks of his seizures and his twisted up body and I cannot stop crying. I can't forgive myself for hurting my little boy. Please help me to work through this emotionally.

Thank you in advance for any help or support.

 

OMG so sorry that happened. How terribly scary! Thank goodness you were there to help him through it and get him right away to the vet! Are you testing his levels at home? What kind of insulin and what was his dose?

 

Anna,
This was my biggest fear about the whole thing. Do you do home testing?
Home testing is a wonderful way to make sure you cat is safe, it means you know when not to give the insulin shot. And also lets you know if you need to give some higher carb food to 'steer' things in a better direction to stop their bg dropping so low.

Once you have that sorted you will find everything else much easier and safer.

Some cats get more sensitive to insulin after a hypo.

The drip I'm guessing was glucose to get his levels back up to safety, I don't know but don't believe there should be any long term damage done.

The catheter means they have instant control of the situation and also because it means they don't have to put anything in the mouth that might cause problems or do you mean a urinry one?

Please do not blame yourself you were trying to help him and no one can fault you for that,
I don't believe they are in any pain or distress when they have a fit. My old kitty had epilepsy that was triggered by specific noises. I can't remember the name now, but was always reassured by my vets that although he may yowl or lose bodily control he was not aware of any of it.

 

I was thinking the same thing. If this had been yesterday, I would've been at work.

The vet told us to give him 2 units of insulin (PZI), twice daily. For us, that's 5am and 5pm.
I test his blood sugar twice daily as well. It has always been in the mid to high 300s. However, this morning it was at 155. I still gave him the insulin. Obviously, it was way to much insulin. Or...maybe I shouldn't have given it to him at all. I was asking myself (in my head) too, if I should skip it. I am completely riddled with guilt that this happened.

 

Sounds like that might be too much for him. At the start I wouldn't shoot under 250. Then 200 but that depends on which type of meter your using. If you go to the prozinc forums they can advise you on doses etc. But will need to see your numbers to have more information. +5 and +6 after the shot are really important too as these let you know how much kitty is dropping.

 

It makes me feel a lot better, TempestsMum, that they are not in pain during seizures.

I don't know what type of catheter. I didn't know there were others besides urinary catheters. LOL... I think though, that they did both (catheter and IV fluids).

 

They sometimes put a drip and catheter in the catheter is like the ones we get in our hands so they can inject quickly I wonder if that's what it was. Butterfly we call them here, it means they can inject immediately without needing to find a vein first.

I'm glad it does as I was so distressed when it happened and every time I checked with my vet and they always reassured me that he didn't know anything about what happened. He was always a little confused when coming round but was purring in no time after every episode so I did believe them.

 

Please take some deep breaths. You did nothing wrong. It can be very hard to know what the best insulin dose is at the beginning of therapy and kitties can take time to adjust to being given insulin. A hypo incident is very scary but, for now, Malakai is where he needs to be for close monitoring. I'm not sure but he may have been catherized because of his condition when you got him there. It might be standard emergency protocol. You can ask your vet later.

Let us know what insulin, dosage and blood glucose testing instructions your vet gave you when Malakai was started on insulin on 08/21/16. People here can guide you through the methods we use to keep our kitties safe - ie., give the dose of insulin that gives good control of blood glucose while avoiding hypo incidents as much as possible. It calls for keeping a close eye on glucose levels and there will be times when you're watching Malakai like a hawk and other times when you can relax a bit. Lots to learn but worth it. We're here to help.

 

Thank you for helping me through this. I cannot even begin to express my gratitude. I've been crying nonstop all morning.

Our vet only told us to give him 2 units of insulin (PZI), twice daily. He also told us to check his blood glucose levels in the AM and the PM. He did say that a hypoglycemic level is anything below 70, and that normal is between 70 and 130.

I saw (on this website) that there's a chart for how much to dose, based on the blood glucose reading. In my case, I should've only given him 1/2 unit (based on his blood glucose level of 133 this morning). If I could go back in time, I would have skipped it altogther. And what made things worse was that Malakai has a cold right now. He was totally congested and had a stuffy nose. I don't know if this complicated things.

 

Every insulin is different and every cat is different. So dose depends on kitty and insulin and food as well.

I wouldn't personally have given anything at under 250 until you have more data on how low Malakai is dropping at +5 or 6 but maybe I'm wrong? I'm pretty new to this whole diabetes thing too. Poor kitty I'm sure that's not helping either with having the cold.

 

Hi Anna,

I suggest you start a thread on the ProZinc (PZI) forum. I'm not expert at reading BG (blood glucose) spreadsheets or giving dosing advice but I think the experienced PZI users would tell you that a starting dose of 2 units twice a day is higher than desired. One unit twice a day is a good starting point. We always test BEFORE a shot is given so we can decide whether the planned dose is OK, too high or too low. Getting the knowledge to judge this and the confidence to react appropriately comes from tracking kitty's responses to insulin doses on a spreadsheet. Patterns will emerge over time and you'll get better and better at figuring out what's going on and what dose to give. They can still throw you a curve ball occasionally but at least you'll know that's what it is.

Other important things: what type of food Malakai eats, what type of glucose meter you use, other medications or health concerns he has, etc. Also - if your vet gave you U40 syringes to give the PZI insulin, you should purchase some U100 syringes which, by using a dose conversion factor, allow you to give PZI in small fractions of doses. This sounds harder than it is ..

 

Anna

You did exactly the right thing in handling the hypo - even got a test in, well done. It must have been very scary, especially when you are only just starting out. You are home testing which is great. Insulin is a hormone so cats can react to it in different ways on different days. It sounds as though your kitty is in safe hands now, my kitty has never had a bad hypo but if she had I would be a wreck so your emotional reaction is 100% normal. Now you have joined the site you will find a wealth of information as well as a lot of experienced people who can help you. My kitty has just changed insulins so I am needing a bit of hand holding at the moment, come and join us on the Prozinc/PZI forum when you are ready where you will find some great advice and support.

In the meantime there are lots of sticky threads around the site to help you learn a bit more about the care of diabetic cats and about your insulin. The guides are just that, guides, as every cat reacts differently and dosing is based on the readings you get from your cat. Please keep us updated with progress.

When you have your breath back you can set up a google drive spreadsheet - available on the site - so you can keep track of readings and make it easier for people to give advice if you put the link into your signature.

 

Hi Alexi. Thank you for your support, hugs, and advice. I did go over to the PZI forum and posted a thread there. I'll check out the spreadsheet too, but am having a hard time finding it. Can you give me the steps to find it?

 

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ you will need the spreadsheet for a human meter and will need to set up a google account if you don't have one - if you do just sign in to it then follow the instructions.

 

Thank you!

Great news! The ER vet just called. They said that his blood sugar is back to normal, he's sitting up, and he ate!! Thank God! His Guardian Angel was there.

 

That is fabulous news! I have responded to your thread on the PZI forum. I have to pop out for an hour but will be back and check in.

 

That's brilliant news Anna! Go Malakai!

 

Such good news!

 

You are his Guardian Angel. When he is home, you can start testing yourself and keep him safe.

 

So I have a legal question... Can the vet hold my cat overnight *another* night against my will? Malakai spent the night in the hospital for observation. This morning, I called for a check-in. They said that his most recent blood glucose level was at 463. It has skyrocketed again. This is almost the level it was at when we first started treatment. I *know* that he's stressed out, as he's at an EMERGENCY clinic, where there are nothing but stressed out animals and people. I will be able to speak to the actual doctor in about an hour. But can they keep him again overnight without my consent?

 

If you tell them you won't pay for another day, see how fast the release him. He probably bounced and that why the higher numbers. For some reason doctors don't know about bouncing. And they end up prescribing to high a dose so when you give it at home the cat goes seriously hypo.

It takes more than one day to regulate a cat. One 12 hr cycle of "normal" numbers does not mean regulation. Look at any ss here you will see.

 

Can you explain to me what "bouncing" means?

 

Very basically - It means the cats system is fighting against the insulin (foreign substance) so over produces to compensate.

 

When a kitty glucose goes lower than what the body is use to, the liver panics and releases glycogen which is sugar and it causes a spike to the higher number. It can take a few days for the high to clear out.

Example, Smokey was use to being in the 400's so to him it was normal. When he dropped to 200's for him it's to low and wasn't use to it, so glycogen was released. Over time he started staying lower for longer periods so the bounce lessened. Now if he hits a 100 he bounces to the 200's. But we are getting more blues and shorter bounces. His bounces only last 12 hrs or less instead of 3 days.

Home testing allows you to see the patterns and catch a drop to serious lows (most of the time) so you can intervene before it's to late.

Look at Smokey ss for 8/21. The green he hit was to low for him, so it caused the bounce up to the 300's and 400's. So lowered the dose and hit green again but only bounced up to the 200's. On 8/26 he hit another green but it was still the higher dose in play (Lantus is a depot insulin). So he bounced to high 200's. The depot has to readjust yet so he will be in 200's for a day or two. This is bouncing. Some kitties are extreme with it, Smokey is an extremist. He is long term and had many months in between of not getting his insulin.

 

It can take days to clear a bounce, and the high reading could be vet stress. My approach would be to tell them they are welcome to keep him another night but you will not be paying for it and it will be at their expense, or alternatively you can take him home where you will closely monitor his levels and call them if you have any concerns. Put like that I don't see how they could reasonably refuse to let him home.

 

http://www.felinediabetes.com/FDMB/threads/dose-help-needed-after-bounce.163910/

Above link is her current thread.

 

Anna, you will probably find that some vets treat FD differently what we believe (here on FDMB) is the better way.
The most important thing is that we never start kitties on a high dose like that. The reason for that is that you give a very powerful substance (a hormone) and you don't know how your kitty is going to react to it. So your cat has high BG and all of a sudden his body receives a dose of insulin which can bring the cat into low numbers which is something new and sudden so cat's liver has this protective mechanism of bringing BG to a higher level - we call it bouncing. So it is better to try to control diabetic cat with a smaller dose of insulin to reduce bouncing which is not good for the kitty. After some days of being kind of conservative with the dose we can think about increasing or sometimes lowering the dose depending on the response you're getting from your kitty.
The most important number is something called nadir - it is the lowest number in the cycle.
I'm trying to be very brief here, just to bring you attention to important things.
Please read everything here - there is lots of important information and the more you know the easier it will be to get your lovely kitty into remission. We all here share our experience and we will guide you so you have massive support.
I'm really sorry about you almost tragic event, you must be very shaken! Not to mention your bank account. Don't let vets bully you.
Malaki will have high BG for few days until the bounce will clear. Now home is the best place for her if she is stabilised and her BG is high.
Please rest now with your kitty at home, you both need time to distress. Don't blame yourself, you haven't done anything wrong, your vet is not what I would call a good vet. Time to think about moving elsewhere.
Ask questions.
Hugs,
Marlena

 

My old boy, Ricky Rudd , was dxed about 4 years ago. He has been getting between 4-6 units of lantus bid and has been on a low carb diet. About 2 years ago he started having seizures a couple times a month and we began to give him syrup and extra food after . His bs was usually low, between 50-80 after the seizures, and after the syrup and extra food he seemed to feel better. His seizures increased to 4-6 times/month and January of last year, January 4, he had three seizures in an hour and a half and remained stiff and unresponsive. We gave him syrup and rushed him to the ER vet. His BS was 80 and they kept him and monitored him through the night. He was better in the AM and we took him to our vet. No insulin in the AM and he appeared better in the afternoon. The Dr. was concerned that it was epilepsy and started him om 10 mg phenobarbitol once a day and he continued to have the seizures. The last month he has had at least 2 seizures a week and his pheno has been increases to 10 mg/bid. Any other experience with this? It's hard to tell if it's the sugar or epilepsy. Help?

 

@clarbineds ....It's best if you start a new thread for your questions so it'll get noticed more. Just go to the top right and find "Start Thread" and go from there

Are you home testing or are those numbers only after you've given syrup and taken him to the vet?

 

you've reduced your dose after those low readings, right? You aren't still giving him 4U I hope if he's having Hypo seizures.

 

@clarbineds

I hope your still here. What do you mean he is getting between 4-6u of Lantus a day? Lantus dose should be consistently the same everyday AM and PM. You don't change it based on current blood test. It should stay the same until a curve is done and then adjusted based on the lowest reading (nadir).

I think the amount you are giving is high unless there are some conditions that are confirmed by blood test.

The seizures could be a result of hypoglycemia if your giving that much and not testing.

Please get your own thread going here for advice.

 

Thanks. I'll start a new thread when I get home later.
The numbers are after syrup, food and at the vet.

 

We skip the next injection after a seizure.

 

Will start new thread later today. His dosages have changed sometimes over the years after testing. Right now he gets 4u am and 5u pm. This testing has been done at the vet and is the vet recommendation. He hasn't had a curve done in almost 2 years.

 

Please start a new thread right away. You could possibly be giving to much. Long long overdue for a curve. You can do them yourselves. Normally done weekly so dose can be adjusted. Now he might have epilepsy I don't know, but it could be from to much insulin causing hypo episodes. We have seen first hand how vets advice can be extremely serious and sometimes fatal.

 

It's VERY possible that the "seizures" are hypoglycemic in nature and not epilepsy then, but of course it's possible there are both types going on. PLEASE start home testing as soon as possible. It's really easy and we can help you learn everything you need to know.

It sounds like your vet doesn't know what they're doing (a common theme around here I assure you)

If you live in the US, WalMart has their Relion Confirm or Micro blood glucose meters that are quite popular around here. They take the tiniest sample size and the strips are affordable ($35.88 per 100)

If you can, I'd stop and get yourself a meter, a spare box of strips and a box of lancets (26-28 gauge...usually marked "for alternate site testing") so we can get you started home testing and keeping your kitty safe

 

Thank you Chris, my gut says it's not epilepsy.

 

Anyone know if Clairbineds started a different thread? I was interested to know what was going on there.

 

Not yet...I've been waiting too

If you want to see if there's another thread going, you can click on their name and go to their profile page and click on "postings"

 

I've been checking and haven't seen anything. Hope we didn't scare them off. Let's try a tag.

 

@clarbineds

Are you still with us? We tend to worry, please let us know what is happening.