New member - Pumpkin 13 year old diabetic, post-severe hypoglycemia

hello!
I'm new to the site and joined out of curiosity about whether or not anyone has experienced the same situation that I'm currently in with my cat. I have a 13 year old tabby cat named Pumpkin who recently had a severe hypoglycemic episode about a week ago. Pre-hypoglycemic episode he was at 4 units twice a day, and the apparent cause of the hypoglycemia was a change in his insulin needs (even though his levels were just checked at the vet a few weeks before). Post-hypoglycemic episode he is now at 2 units twice a day although his blood sugar levels have been very erratic. The vet says that the trauma he has gone through from the hypoglycemia makes it harder to regulate his blood sugar.
My main concern has been with his recovery since the episode. The first day or so after he had a few grand mal seizures (with convulsions), one of them leaving him blind. These seizures seemed to stop for a little over a day and then he began to experience petite mal seizures (without convulsions) semi-regularly throughout the day, at one point they occurred every hour on the hour. His vet described these petite mal seizures as being "residual" due to the damage done to his brain and said that these seizures, as well as the blindness, should go away with time as his brain heals. He did not prescribed anti-seizure medication right away.
All was well with Pumpkin for a few days despite these petite mal seizures and behavior wise he was acting like himself, and was even able to navigate my room and appeared to be getting his sight back. He has also been eating, drinking, and grooming himself throughout his recovery. However on Wednesday he had another grand mal seizure and it left him in a very withdrawn state, he seemed to be in constant fear of having another seizure, his vision also appeared to be getting worse. At that point my vet prescribed him phenobarbital, but told us it was not a good sign that he was still having seizures and that this may be "the beginning of the end." We gave the medicine but it did not seem to do much since he was still having regular petite mal seizures and then had multiple grand mal seizures again on Thursday night.
On Friday my mother contacted our vet again, and he prescribed us Keppra (levetiracetum) since it apparently is stronger and has a quicker effect than phenobarbital (which apparently only kicks in after two weeks?). I don't want to jinx anything but since starting the new anti-seizure medication Pumpkin has not had another seizure, either grand mal or petite mal. It has now been over 24 hours since his last seizure and he is becoming more of his old self and has been purring for the first time in days.
However, I'm not sure what to expect from here on out. The state he was in before starting Keppra had us considering putting him to sleep if he had not improved in a few days, since with each seizure he was acquiring more and more brain damage. It's not a decision we came to lightly at the time, but it had been awful to see him suffer through multiple seizures a day, especially at his age. However since he has been improving we have obviously disregarded putting him to sleep as an option for now.
I was wondering if anyone else has ever experienced something similar to this situation, and if so how did their cat do recovery wise? My main concerns at the moment are that he has not appeared to have really slept since we brought him on Monday. He seems to doze in and out while laying down, and he may be sleeping at night while I am also sleeping. He also is a little uncoordinated, and still appears to have slight head shaking which kind of looks like a tremor. He also has only had one bowel movement since he's been home, which I guess may be an effect of the medication he's on as well.

I'm sorry for the lengthy description! It's been an eventful week to say the least. Any insight about Pumpkin's current situation would be greatly appreciated!

 

My very first thought is that you may want a 2nd opionion from a vet with experience in treating seizure disorders. Are you still giving 4 units twice a day? If yes, you need to reduce that dose as you have proven it is too high. Cats who have experienced severe hypoglycemia are often much more sensitive to insulin afterwards.
And my 2nd thought is to encourage you to go to a pharmacy today now to pick up a human glucometer, test strips, and lancets for alternate site testing (they're bigger) and start testing your cat's glucose levels asap. A Target Up and Up or WalMart Relion Confirm are inexpensive to use, and we have guidelines for glucose ranges. We'll coach you through testing and it is vital you know if the seizure is happening because the glucose is too low. Have you got any Karo syrup? If he has another seizure, use an oral syringe to get an mL of Karo in asap. Then test his glucose level. It should be above 50 mg/dL for safety. Later, when you have time, you may want to get a pet meter, although they cost more, as the numbers are more familiar to the vet.

What insulin are you using?
What are you feding?

 

Firstly welcome to FDMB.
There are many very experienced people here who will be able to help you I am sure. They may not be online right now but will come back on at some point either today or tomorrow.
I am so sorry you have had such an awful time with Pumpkin.
He was obviously getting too much insulin.
I can't help at all with the seizures, I am sorry, but there are others who can I am sure.
But I think one of the best things you can do right now is go out and buy a blood glucose glucometer and start testing Pumpkins blood. The blood sugars change over the day and are different on different days, just because a test was done at the vets does not mean that it will stay the same. Cats frequently get stressed at the vets and their blood sugars are higher than they are at home so a true reading of how he is, is not being taken.
Many people ...if you are in the US.......use the Walmart brand......Relion Micro or Relion Prime.
I have just noticed BJM has just posted ....she is very experienced.
Don't give up.
I agree ....get a second opinion.

 

Thank you for your response!

We adjusted the insulin down to 2 units twice a day, the vet had us start at one unit one time a day but his sugar levels got way too high (over 700) and we've been adjusting the dosage up since then over the past week. We also have purchased a glucometer from our vet that is adjusted for cats! Sorry I did not mention this in my original post, but it has been very helpful with monitoring his blood sugar. Our last reading for him today was 314, and although this is very high it is actually the lowest it has been throughout these past few days so hopefully his body is starting to regular his blood sugar again.

We also have karo syrup, but since his blood sugar has been high these past few days the vet has told us that it will not have much of an effect in treating his seizures, since he said that they are caused by residual brain damage due to his hypoglycemic episode rather than low blood sugar levels. We are currently using Prozinc insulin, and feeding him science diet wet food (for mature adults 7 years and older) and science diet dry food. He doesn't have much teeth left at this point so the wet food seems to be working better for him at the moment.

 

Both those foods are too high in carbohydrates, but at this point I would not change him over to lower carb food until he is more stable. Also canned wet food is much better than dry for cats.
So are you now giving 2 units twice a day.?
Are you testing inbetween the shots to see how low the dose is taking him?

 

If you could start a spreadsheet when you have time it would be a great help to the people helping with dosing advise
Here is the link how to do it. If you have trouble doing it ask for help.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
Is the monitor you are using an Alphatrek?

 

Okay thank you so much! Are there any brands of cat food that you would recommend? I feel more comfortable sticking to the wet food at this point since he seems to have trouble chewing the dry food and I want to ensure that he is getting nutrients in.
Yes we have been testing in between shots, however before his first dose this morning at 8am he was at 470, and then at 11am it went up to 561 which was surprising... but then we last tested him before his 2nd dose he was at 314.

As far as the second opinion he has seen a few different veterinarians this past week because he was initially admitted to a 24 hour emergency animal hospital where he saw two different vets and then admitted to his regular veterinarian where he has seen his main vet as well as two other vets when his usual doctor was not working. So far they have all agreed on the fact that the seizures have been an effect of the hypoglycemic episode and that due to his age it has made it harder for him to recover.

I will definitely start a spreadsheet! We are currently using an "Alphatrak 2" monitor.

 

Here is a link to food which is suitable for diabetic cats. I am assuming you are in the US.
http://www.felinediabetes.com/FDMB/threads/food-links.133016/#post-1512975

A lot of people use Fancy Feast classic pates as they are low carbohydrate. You need a food that is 10% carbohydrate or less.
If you find some foods you like...post and ask if they are OK.
HOWEVER IF YOU ARE GOING TO CHANGE OVER TO LOW CARB FOOD YOU NEED TO DO IT VERY GRADUALLY AND GET HELP FROM SOMEONE HERE......AS THE BLOOD SUGARS WILL MOST LIKELY DROP WITH THE LOWER CARB FOOD.

 

Thank you!! I really appreciate it, and yes I am in the US!

Okay great I will definitely start looking into lower carb food, my father had actually suggested that his food might be the problem as far as how high his levels have been. Perhaps in a few days we still start to gradually add some low carb food, but I will be sure to post here before doing so. Right now I think I will try to keep things as is, since I am afraid of adjusting anything from his routine at the moment.

 

We always recommend you test before giving insulin and we call that AMPS (am preshot) AND PMPS (pm preshot).
A cycle is 12 hours from shot to shot. So if you gave the insulin at 7 am that would be AMPS and twelve hours later at 7pm it would be PMPS.
Inbetween those times we have
+1 to +12 because we all live in different time zones. If you tell me you took the blood sugar level (BSL) at 10 am ....I live in Australia so I would have no idea what time you had taken it ...but if you say you took it at +6 I would know you have taken it 6 hours after the insulin was given.
The Nadir is the lowest the blood sugar goes and is an important reading.
It is important that you get a few reading inbetween the shots as that will tell us how the insulin is working and if it enough or too much.
I have just realised we do not know your name!
I have no experience with Prozinc insulin as I use another type but I will tag a few people who I know have experience with that and they can guide you with that.
@Sue and Oliver (GA) @BJM @Elizabeth and Bertie @Merlin
Pumpkin uses Prozinc and I was wondering if you could help with his dosing .......he has had a major hypo and seizures and his mamabean needs help and support. Thanks

 

This is the Prozinc forum
You will see some yellow "stickies" at the top of the page. They have a lot of info about Prozinc in them
http://www.felinediabetes.com/FDMB/forums/prozinc-pzi.24/

 

My name is Jaclyn!

Okay great thank you so much I cannot tell you how much of a help you have been! I will get started on his spreadsheet when we give him his shot in the morning.

I will also check out the Prozinc forum!

 

Oh gosh, as I read your situation with Pumpkin, my heart felt so sad. Bron gave you some great information regarding Prozinc, setting up the spreadsheet and how it works. If you could get that spreadsheet started and filled in, that will help out immensely. I am going to give you one more link and that is the Prozinc protocol: http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/ as well as www.catinfo.org. They are both great reading. Also please read on how to add information to your signature such as your kitty's name, age, insulin, food, health issues, meter type, etc.

According to the Prozinc protocol, we usually start low which is about 0.5 or 1.0 units and then we adjust from there. Anyhow, so glad you are testing. If you get a 200 for an AM or PM preshot test, we advise not to shoot. We then suggest to stall say about 20 minutes and if it gets above 200, then we shoot and probably with a reduced dose. Prozinc is called an "in and out" insulin which means that it pretty much lasts only 12 hours. Prozinc should give you like a "smile" on a graph which means anywhere from the +5 - +7 hours, should be your lowest number. With Prozinc, doses can be adjusted with each test however some kitties, need some consistency to settle in to a dose. Anyway, that is why we have a spreadsheet...to tell us that information from the data you collect.

Pumpkin, you and your family are in my prayers and I hope for a speedy recovery. If you have any questions, please holler either on the Health or this forum. You can post on the Prozinc forum too but may also want to post on the Health forum as well if you have a question as we are a much smaller group. Especially with the hypo and seizure situation, you will get much more eyes on your question.

 

Hi Jaclyn!
Welcome to the FDMB. I do hope we can help you get Pumpkin back to good health.
Put any BSL reading you have already done into the SS and make sure you note that you are using the Alphatrek monitor.

 

Have you got any Karo syrup? If he has another seizure, use an oral syringe to get an mL of Karo in asap. Then test his glucose level. It should be above 50 mg/dL for safety. Later, when you have time, you may want to get a pet meter, although they cost more, as the numbers are more familiar to the vet

Sorry I need to jump in on this part. Do not squirt any liquid in the month during a seizure. The animal can choke and most likely will aspirate it into the lungs. That will bring on even more problems like pneumonia. Wipe it on the inside of check or tongue with your finger.

 

Jaclyn uses an Alphatrek meter so she would need to intervene at 68 mg/dL not 50 mg/ dL.

 

It sounds like you and Pumpkin have had a horrible time. I hope we can help.

It may be that he has been consistently overdosed. The problem with getting the tests done at a vet is that most cats are stressed at the vet and stress raises bg levels. Then doses based on those inflated levels can be too high once he gets home and relaxes. I am so glad you are now testing at home and can get some accurate data.

If he were mine, I would get some numbers ASAP. Always get that number before the shot (and don't shoot if under 200). Then try for a number 5-7 hours after the shot. That is usually the lowest point (though it varies with the cat) or nadir. The one cycle where you got some numbers he went up at nadir and back down for the next shot, right? That is often indicative of too much insulin.

Once you have some data and it is pointing toward too much insulin, I would reduce the dose (maybe by half) and start changing his diet to low carb. Some cats can tolerate an instant change; some tummies require a slow gradual change.

For reference: we consider a cat regulated if they are in the lower 200s at preshot and in double digits at nadir, but not below 50 - which is approaching hypo territory. You are using an AlphaTrak so your numbers will be a bit higher. (Most people here use human meters so we have to consider the different levels of each)

We have cats here who had horrid hypo episodes, went temporarily blind and recovered. For that issue, I would post on the Health forum with his specific symptoms. For dose help, please come over to the PZI/ProZinc forum.