Lethargic, uncoordinated movements, 25mg/dL

This morning I woke up and my cat had pooped on the floor, and after giving her food, she wouldn't eat it. She ended up walking over to the couch and lying down, then peed a little bit. We gave her some food and she started eating a bunch, but kept trying to walk forward while eating, and when I let her go she wandered into a corner and just pawed at it. I extremely foolishly gave her a shot of insulin, and after being unable to get a blood sample from her ear, I took one from her pad, and it came up with 25mg/dL. I already gave her a bit of kyro syrup with her food and on her gums, but I think I should give her more rectally. I have a syringe, but how much should I administer? My vet is closed today so I can't contact them.

Thanks

 

I have orally syringed Kero mixed with a little canned food. Yuu can also try using about 1 ml of kero rectally

 

I've already given her lots of karo orally, but I'll try the rectal application.

 

She seems to be moving around less (instead of the aimless moving) which I'm going to take as a good sign. I gave her some high-carb wet cat food and poured some syrup on top of that, and she's eating it intensely now. I tested a second time after about 15 minutes and got 30mg/dL.

 

Have I understood you correctly that you've given insulin at a blood glucose reading of 25mg/dl (1.3 mmol)?
If so this is an emergency situation. Do you have access to an ER vet?

What insulin did you give and what dose?

Eliz

 

We tested about half an hour to an hour after the dosage. We've been giving her a steady 2 units twice a day for the past month or so. I tested 15 minutes after the 30mg/dL and it's up to 52. I'm going to continue testing every 15 minutes, but she seems to be out of the symptoms. She's just sitting licking herself right now. Also I gave her some of the "emergency wet food" that's high in carbs, and added syrup to that. She ate about 2/3 or 3/4 of a can, in addition to her ~3oz of homemade food.

I'm not sure about an ER vet, but there are quite a few vets around here that might be able to help; I'll look around.

 

How long ago did you give the shot?

And be aware, that glucose/syrup acts quickly but also wears off fairly fast (in my cat in about 40 mins) added to which the effect of the insulin will increase.

Eliz

 

I gave her a shot at 1PM, it's 2:30 now. Testing again and I'll report back in a few minutes.

EDIT: Latest test is 59

 

It's great that you have her out of those dangerous numbers - now we need her to stay there. As Elizabeth said, the karo and carbs do wear off, so you need to be diligent about testing for quite a while. Our general rule of thumb is that you want to have two normal/safe tests in a row that are NOT influenced by food.

Also, don't feed too much at once. For one, we want to avoid a scarf-n-barf situation, and just as importantly, we want to be sure she will be willing to eat more high carb food if necessary...we don't want an over-stuffed kitty too early on.

You are doing great with the testing and karo. Keep keeping a close eye!

Additionally, these lower numbers do mean your kitty has earned a dose reduction.

 

Be prepared; you may not be able to feed your way out of this one, so do please find the number/address of a vet near you who can help if necessary.

What's your name? And your kitty's name?

Eliz

 

i'm glad you're on top of hometesting! A 25 with symptoms as you've described can be an emergency situation with Lantus. Lantus hypos can last 16 hrs, even, so please continue testing every 30 minutes until you see she is safely up and staying up above 50.

Elizabeth is right, you may need a vet. Lantus typically onsets about 2 hrs after a shot, and then you can expect that it will typically lower your cat's numbers.

As long as you're able to test every 30 minutes and can report back here, you can try to handle it on your own, but with shooting that low, i wouldn't hesitate for one minute to take her to a vet to monitor.

you can also give her dry food to pull her up. that usually lasts longer and today might be the day that's appropriate to do that. i think that would be a good option in your case.

i want to teach you a little more, but will write it in another post.

 

She tried eating more food, but as you said she might have had too much, so I took it away to save for later. What would a vet do in this situation? Keep testing and administering food if needed?

Also I found a 24/7 vet nearby that will be able to help if needed.

I'm Sam and my cat is Sheevee.

 

A vet would administor a glucose IV drip to get her out of the hypo situation. I'm glad you were able to find a nearby ER if you need it!

 

a vet might put her on a glucose drip. If you're prepared to test her every 30 minutes you can try to do this at home. just keep the info on the vet nearby and if you have any doubts, take her in the car and go.

to raise blood sugar you can give her a drop or so of karo and wait 30 minutes and retest. your goal is to keep her above 50.

when you can breathe, read this post. it can wait for now.

cats settle into doses - a 2.0u dose might've been just right before, but if a cat stays in normal non-diabetic numbers (50-120) their pancreas can heal and begin producing insulin again. that may be what you've got going on. We hometest so we can adjust the dose to reflect the constantly changing need.

again, not now, but when you have a chance later today, can we get you to make a spreadsheet? we are data driven here, and the numbers tell us exactly what's going on in her body. How to set up a spreadsheet & link it to your signature.

you also need to know that a cat that has had a symptomatic hypo, which is what you're describing, can become extremely hypersensitive to insulin.

you'll definitely need to reduce the dose tonight, depending on what happens today. I'll check back in with you in a while - others have their eyes on you as well.

 

I tested her again and it's down to 53, so I gave her a little more syrup in her gums. I'm really worried that the lantus will have too strong of an effect, and I'm kicking myself for administering it when I shouldn't have. I've been testing every 15 minutes, but now that it's starting to go down again should I still do every 15 or move up to 30 minutes?

I'd like to take her to the vet, but my family has been fairly tight on money for quite a while now, and an ER visit will probably cost upwards of $300 or more. I'll give them a call either way and see if I can discuss with the doctors on pricing and procedures.

 

You're doing great! You want to keep her above 50 and so far so good with that. You're doing great with the testing, too. Do you have enough test strips on hand? I would retest in 20-30 miutes max for right now. As long as you can keep her above 50, a vet visit shouldn't be necessary unless you see the return of symptoms, but you do need to keep up with the frequent testing to make sure she's staying in the safe numbers.

 

I called the ER vet, and they said the initial diagnosis would be $95, and an extended stay would be around $900, so we're on our own here until we can call the regular vet tomorrow.

 

Sam,
You don't know me from Adam, and this is a crappy way to meet.

In your shoes, I would be headed to the ER vet. I have seen a cat go hypoglycemic, seize multiple times, go into a coma and die. It took two days and it was the most horrific thing I've ever seen.

Carl

 

the thing is that none of us can predict what's going to happen in Shivee. There's no way to know.

i'll set a timer and be back in 20 minutes.

 

just fyi - 50's & over are safe numbers.

40's are take action numbers for a cat that is on insulin. we don't want cats to remain there because there is no safety margin.

under 40 is dangerous.

Lantus typically onsets about 2 hrs after the shot and typically the curve will go downward for the next several hours.

it's your call.

 

15 minutes after the last one it's at 48. I gave her around 5mL of karo syrup by pouring it over a treat and she just kept licking it up. I hope it wasn't too much but she seemed happy doing so.

 

I'm glad you have the syringe for a rectal application for just in case.

How many hours has it been since the shot now? 2 hours?

 

A little more than two and a half hours. That probably explains the slow drop in levels. Hopefully the syrup is enough to counteract it. It'll just take a little while to act because it's going through her stomach instead of her gums. I did put some on her gums but she really didn't like it, but all of the stuff I put on her gums/mouth is gone so she probably licked it off.

 

15 minute check in and it's at 74. The syrup is taking effect I'm guessing. I'll check it again after a half hour.

 

Okay, test again, in 30 minutes, no longer, please.

 

That is excellent, but as Dyana said, 30 minutes max for her next test! We need to keep her in these safe numbers, and it could be a long haul, given the timing and starting point.

 

Don't be concerned or surprised if the numbers continue to go up. If her system is functioning somewhat normally, her pancreas and liver will instinctively trigger a release of "sugar" into her bloodstream as a self-protective mechanism in response to critically low blood glucose. If you see a 300 or even higher, it will be primarily due to that, and not the direct result of the Karo or anything else you've given her.
You just don't want to see more "drops" in BG anytime soon. If you do, then feed/Karo like you've been doing.

 

I'm definitely willing to continue the tests throughout the day, and I have plenty of syrup left and I'll give her food at the normal time in a few hours.

 

we "speak" in how many hours since the last shot was given, so it will help us all know what the significance is of her numbers if you can tell us the tests in "+" form.

i think i've got an approx of your tests so far:

her amps (am preshot) was 25
+.5 = 30
+1 = 52
+1.5=59
+2 = 53
+2.5= 48
+2.75 = 74

just give all the test results in how many hours post-shot it's been.

you're doing great so far. keep it up. don't go longer than 30 minutes without testing - you've got to do this for probably 6 more hrs or so.

if you give her food, keep it small. the carbs are all in the gravy. usually 1tsp of gravy is enough to move up the numbers. you don't want her to fill up and refuse to eat.

 

I know you need to try and work this from home due to the cost. Please have your spouse call care credit and see if you can get approved and then get to an ER.

I've worked situations like this with members for hours and hours and had the kitty go up only to come back down into the 20s. She needs to be on a glucose drip and to be evaluated to be sure she does not have residual issues from the symptomatic hypo.

 

also - you don't need to feed or give karo when she's over 50 or so. she might fill up and refuse to eat later if you need it, so don't carb her now.

 

You're doing a great job, but your cat has had a symptomatic hypo and then another shot of 2 units was administered.

I've seen overdoses on Lantus run as long as 16 - 17 hours.

The numbers may be relatively easy to keep up now, but kitty has yet to reach the expected low from the last shot. As time goes on the likelihood your cat will vomit and probably have diarrhea from all the food and karo used to keep the blood glucose numbers up becomes greater. BG numbers could plummet. At that point you'll be in trouble.
Big trouble.

I know everyone is being nice by helping you keep kitty's numbers up (this is NOT a typical low numbers cycle, folks!), but the BEST advice you've received on this thread is to take kitty to the nearest ER immediately. Once there, the vet will put him on a glucose drip. Kitty may not even need to stay overnight. It all depends on how things go.

PLEASE go to the ER. Worry about the money part of it later. Try to work something out with them. Please. Go now.

 

I want to, I really do, but I really really don't have the money. It was hard enough after her initial diagnosis to pay the vet bill and buy ($250) lantus, syringes, and ingredients for food every two weeks. I might be able to go to the regular vet tomorrow for a check-up, but even that's difficult. If anything, we might just have to put her down. Marjie suggested care credit, but looking over the site it just looks like a quick loan business, which means we'll have to pay the $1000 sooner or later anyway.


EDIT: After 30 minutes from the last test* it's at 140.

 

My civie needed an emergency surgery about a year ago. I signed up for Care Credit that day, got approved instantly, and was given the account number so I could use it right away. You can pay it off monthly like any other credit card.

 

It's not about paying the money NOW; I could do that if I had it to spare, it's about paying it in general. $1000 is $1000 no matter if you pay it today or a year from now.

In addition, she's nearing on 11 years of age so even if she is fixed today, any more outbreaks will cost more. I'm leaving back to college in a month and a half, and I've been her primary caregiver for these past few months post-diagnosis. My family is helping out as much as they can, but it's tough, and when I'm gone I just don't think it'll be viable for them to keep her going. I've also been making food every two weeks in attempt to improve her condition, and I believe it's worked, but that's another responsibility that I'll be leaving to my family.

 

Yes, my understanding is Care Credit is a loan which will eventually need to be paid back. I really don't know much more about it.

Love hearing about that 140!
I guess all you can do then is to continue testing if there's not any possibility of getting to an ER...

 

Here's a link to other financial aid resources:

Financial Aid & Other Resources.

 

Right. It just gives you the option of paying a little at a time (i.e. $40 monthly payments) which might be more manageable. It is a credit card that is exclusively for healthcare services. I just wanted to let you know how it works since I have used it and it's an option. Good luck!

 

140 is encouraging. Test again in 30? Are you good for test strips?

Yes, you would eventually have to pay back the loan like any credit card. Care Credit is a great option because most vets won't accept payments and want all the money up front.

If the ER is a definite non-option, and you think that you can deal with the situation until tomorrow when you can speak to your vet, then of course that's a better option than considering putting her down.

It's hard, but try to take this a day at a time for now. And 11 isn't old really. My sugarcat, Bob was 11 when he was diagnosed. But he was only on insulin for ten weeks and went into remission. She could too. He got two and a half more years of a wonderful healthy life after that before I lost him last November. I wouldn't trade that time for all the money in the world.

 

Latest test was 164 (half hour after last test)

 

Was there any food or treats given in that half hour?

 

I'm glad she is up. As others have suggested, please stay on top of this. I've seen numbers that high before from the karo and they've come back down. We will just hope she is starting to bounce and her liver will release hormones and glucagon to bring her BG a way up.

Please note that cats who have had a symptomatic hypo are often subsequently ultra sensitive to insulin. I would strongly consider skipping her shot tonight. If you feel you must give her some insulin because numbers are very high, please shoot a very reduced dose....a token dose like 0.25u or 0.5u. Please do not give her any insulin from this time forward without checking her preshot blood glucose.

 

I haven't given her any food or treats since that last 5mL of syrup.

 

Will-do.

 

Do you have enough test strips to keep going?

i'm thinking this is 4hrs post shot now. do you have another test yet?

 

Just to add to what Marje suggested....

I wouldn't even give her a "token dose" before speaking to her vet in the morning and letting them know everything that went on today.

Okay, just a suggestion... Try to lay off the syrup if possible. It makes the numbers come up pretty quickly, but it might be too much of a good thing if it upsets her tummy. Many cats if given that much syrup would probably have vomited by now. Do you have any higher-carb food that you might be able to give her in small rations?

 

I do agree with Carl. I'd be concerned about giving her any insulin but she could skyrocket and if she does, I didn't want you to panic about giving her none.

However, I'm thinking I might back the carbs down just a bit to medium carb because we want to give her something that won't wear off. Usually LC or MC helps with that.

 

if i'm reading you right (please correct) you haven't given her any karo syrup or carbs or foods for at least 2 hrs now, is that right?

 

Just tested again (30 minutes) and it's 164. She hasn't had food for 2 hours, no.

 

do you have plenty of strips?

keep it up - you're doing fine. see you in another 30 minutes.

 

If necessary, you can make gravy with a bit of flour, water, and cat food.

 

I'm all set on strips.

 

Latest test is 155.

 

When would she normally eat next?

 

Right around now, but she was fed at ~7AM this morning, and had a lot of food at noon which is not on schedule.

 

If you want to give her some food, that would be fine, I think.

 

i'd offer maybe 1oz of food since she ate a lot earlier. we want to keep her up, but you may need her hungry so she'll eat again later.

glad you've got enough strips.

 

144 latest. Giving her food.

 

good job.

 

Hi Sam

Julie had to run out and asked me to pop in and keep an eye out. Looks like your last test was 144 at +6. You fed. Any further tests?

You all have had a really long day but doing great.

 

I was gone for about an hour and a half, but I just tested now and it's at 96. Is there a specific goal I should be going for?

 

While 96 is perfectly safe, it's her trend of coming back down when she should be headed up at this point that I'm focusing on.

While the nadir (or lowest number in the cycle) is theoretically at +6, some cats nadir earlier, some later (even as late as the next preshot), and some change it up. We don't have any data on her to know what her nadir is but she's also overdose. This can cause the duration of this cycle to be very long (as was stated, it could be 16-17 hours).

So we need to keep in mind that we might need to feed later in the cycle. I'd like to see if she will eat a tsp or two of low carb food and see where it puts her BG. Do you think she would be ok with this? How is she feeling and doing with the tests? I'd feed her and test in an hour. Sound good?

 

I'll give her some of the ground chicken food I've been making. She seems to be doing alright, wandering around the house and sitting in places like usual. She heavily dislikes getting pricked in the paw, but after I give the test it's fine.

 

She won't allow ear tests? You typically have to poke harder to pierce the tougher toe pads.

 

The last few times I tried the ear tests I couldn't hit the vein. I tried shining a light through the back but it was still extremely hard if not impossible to get it. I've found it much more reliable to prick the pads.

 

Ok. When she's through this, we can teach you how to poke the ear. You don't want to hit the vein. It will really hurt and bleed like the devil. We just poke the very edge of the ears. But again, stick with what she will let you do for now and we can address the other later.

 

She didn't end up eating anything, but testing again after an hour it's at 109.

 

sometimes with a hypo event, even though you didn't see low numbers since the 25 this morning, the overdose can influence the next few days. at this point, i don't think it necessarily means a vet visit, but it does mean extra monitoring.

Any chance you have time now to do a spreadsheet? It's going to be very helpful for us to help you as you move forward. Numbers alone don't mean as much as numbers in context, the way they are on a spreadsheet.

see you in another hour. i'm glad she's holding up there.

 

Latest is 111

 

Sam, we're wondering about any BG tests you have from before today. It would be good to consider them when looking at her next dose. Especially the past 3 days, or more - whatever you have.

Have you been doing preshot testing every time? any mid-cycle tests?

 

I have no data from beforehand because I couldn't get any blood from the ears, so it was pretty much blind.

 

I'm jumping in late here... it looks like it has been about 11 hours since her shot, correct? And the hypo was just before that? Last food was when?

My concern is that it has been at least 10-11 hours since a symptomatic hypo. When a cat goes too low, the body is *supposed* to release counterregulatory hormones that would bring the numbers up to a safe zone. Since that hasn't happened yet, hours later, it's possible that either she has been this low several times before and you haven't caught it (often enough that her body has been tricked into thinking super low numbers are ok), or that her insulin dose is WAY too high so it was able to counteract those hormones. It's a concern that the protective mechanism hasn't kicked in yet, so please be vigilant and conservative.

I would concentrate on getting through the next several hours until you see the numbers go up and stay up. In Lantus overdoses, we have seen that take up to 16-17 hours.

HOWEVER. I can't recall a time when we have had a 2u shot given right after a symtpomatic hypo, so we have no precedent to be able to predict what will happen here. I wouldn't even start to think about what dose to give next time. For sure I wouldn't give insulin tonight, and I would probably be inclined to skip tomorrow's shot too (maybe both shots tomorrow) to allow the insulin depot to deplete and the counterregulatory hormones to clear out. Then see where things settle out and decide where to go from there. Honestly I think it would be premature to try to guess what will happen next - just keep testing, feed to keep her propped up, and wait for a bounce to hopefully start soon.

Good job today, though! I know it was trial by fire, but you're doing a good job of keeping on top of things. Let's get through tonight, then worry about tomorrow.

 

we're thinking it'd be smart to skip tonight.

most people do shoot blindly until they arrive here and either learn more or have an experience like you had this morning. you've done a good job handling all of it.

i'm thinking it might be good for you to take the 911 off now - you can edit the first post of this thread to do that - so that if you need it again, you can put it up and it will get noticed.

for now, i'd keep testing every hour and repost the number here. we're still watching for you.

edited to add - i see Libby has weighed in as well. just keep doing what you're doing, sam.

 

Thank you so much for the thorough explanation. I would like to sleep today, but should I wake up every maybe 4 hours and test?

 

no, I don't think you're at a point at which waiting 4 hours is safe. She is still close to 100, right, and about 11 hours after the shot, if I'm calculating correctly. I would stay with every 1 hour unless you see a very significant rise. Set an alarm and catch cat-naps if you need to, but be sure you can wake up. If you're like me and you can't wake up from naps, then I would make coffee and stay awake. Sorry, but that's the tradeoff for not being able to take her to the vet for monitoring. She's not out of the woods yet. These numbers may look safe, but due to the way Lantus works, it can take a long time for the insulin's effects to wear off. Each cycle builds upon the next, it's not strictly a 12 hour cycle.

 

Latest shot is 114. I guess I'm doing an all-nighter.
It's been 12 hours after the shot.

 

when was the last time she ate?

 

I think it was about 5PM. I'll see if she's hungry now.

 

yes, if she hasn't eaten in a number of hours and is still surfing at around the same number, she might be getting past the "pull" of the high dose of insulin. We're just looking to be sure she's at a point where if the food wears off, she won't tank again. Try to feed, see where she is in an hour, then if she's around the same number you might be able to go 2-3 hours between tests. I'm sure she's not terribly hungry since she had so much food and sugar today, but getting something solid into her should help her maintain her numbers.

 

Sam, I'm going to sign off - you're in good hands with Libby.

See you in the morning!

 

You're doing a great job, Sam. Well done.
(And you've had some phenomenal support here).

It's 6.20am in the UK, so I'm around now too. Just getting coffee and then I'll read through all the posts here.

Eliz

 

I've been watching along to see that everything was OK and just wanted to pop on and say "Congratulations" on keeping her safe!

You've had a true baptism by fire today...and now you're getting your very first PJ Party!

Hopefully by morning it'll be easier to know how to proceed, depending on how she does the rest of tonight.

I don't have any brownies to offer you for your party, but here's some

Great Job, Sam!

 

Thanks for all the kind words and support! Checking in with 145.

 

145 is good. :smile:
Did Shevee have much food between the previous test and this one?

 

She really hasn't eaten much, maybe 1oz or so.

 

Aha, so it may be that she's starting to come up on her own now (not just due to the food).
It would be good to see another rising number though, just to be sure that she's definitely on the way up.

How does Shevee seem in herself? Any residual effects from the hypo?

Eliz

 

She doesn't seem much different, though I don't really observe her much at night. I gave her a treat or two and she munched them down.

 

Great job today, Sam. Please keep us posted as to what the vet says. We will all be here to help you learn as much as you'd like to.

Hope she comes up so you can get some rest.

 

Latest is 148. Looks like it's stabilized fairly well. I'm getting awfully tired, so I might take a 2 or 3 hour nap.

 

Okey dokey,

So, she seems to be holding steady (rather than rising or falling) at this point.

Yes, do get some rest. But maybe set an alarm so you can check again in 2 -3 hours?
(I know you must be exhausted...)

Eliz

 

It was extremely difficult to get this reading, but she's at 140 right now with no food so far. I'll give her the normal breakfast with no insulin today.

 

nice job. :smile:

I think you're at a point where she is not at risk of dropping too low from last night's shot. I agree with no insulin today, though. I would give things a chance to settle down before deciding what to do. Test a few times today and keep an eye on her, and please let your vet know about the hypo.

 

Hey Sam!

I did not want to interrupt the flow of the awesome advice you were getting last night, but did want to chime in and say great job on testing and monitoring!!!

I was checking frequently to see how things were going and you did great. I am a newbie myself and I am not sure I would have been able to handle it as well as you did!

Looking forward to hearing what the vet has to say

 

'Morning, Sam. Great job managing Shivee's numbers! Kudos to the members who were free to help yesterday and through the night. I hope you get a chance to relax and get a nap or two in today.

I'm another one who agrees with no insulin today. At this point, don't worry if you see Shivee's numbers rise... and if they don't... that'll tell us something, too. Today's a good day to let everything settle down. Then it'll be time to figure out where to go from here. She'll give us clues.

Like Libby said, get a few tests in today, let your vet know about the hypo, and get some well deserved rest.

 

Sam

I didn't want to stress you with this yesterday but if you need any help setting up a SS, it will take me about two minutes to do it for you. I'll even add in the numbers from yesterday and you can just edit if I have them in the wrong place.

I do need some info from you so they would best come via private message. If you'd like help, please send me a PM by clicking on the PM box to the right under my Gracies photo and just letting me know you'd like me to do it for you. Then I can tell you what info I need.

If you are comfortable doing it yourself, no worries. Here's how you Create a Spreadsheet.

 

Just tested again and it's 240. Still no insulin?

 

Right. No insulin. This rise is natural. It's what we call a bounce, and it's his body's way of protecting itself.

Test again in like 3 hours or so, and let us know what you get.

 

Hi Sam,

I also didn't want to chime in while you were getting all the helpful advice. But you did a great job managing Shevee over the past two days! I'm very impressed - you kept your calm (at least online) and got through it!

I look forward to what the vet has to say about all this.

Good luck!

~Suzanne

 

Will do. Just gave her some food and adding data to the spreadsheet now.

EDIT: Added spreadsheet to my signature. I'm angry that I didn't start this right when she got diabetes.

 

don't worry about not starting earlier. Most of us don't (look at my Lucy's spreadsheet - I knew how to test, but it was still months before I started doing it regularly). I'm sorry you had to be introduced to it all this way, but you're not the first and I'm sure you won't be the last. Just move forward. :smile:

This could be the counterregulatory hormones I was expecting to see last night, or it might not be. If so, it's possible that she will come down from here on her own and I think it's smart to skip the insulin today. Plus, that will give both of you a break from the stress and testing of last night. We'll see where she goes from here!