Newly Diagnosed.. urgent question!

Hello everyone! My cat Hagrid (6.5 years old) was recently diagnosed with diabetes. His levels pre-insulin were around 300, the vet gave me ProZinc and we started him on .5U every 12 hours. His levels started going down but he got VERY sick about a week after starting insulin, I rushed him in and found out he had an infection. So he was placed on antibiotics for 10 days. I got a hometester kit and test him at least once a day. His level was down to 44, and then perked up to the 70's for a few days which was great! Today he was acting fine, eating his FF, admistered his PM insulin (he has been pretty steady around 1.5-2U) a few hours later, I notice he's very sleepy, his nose is pretty pale.. etc. I checked his level and it was at 39!! I panicked! I gave him a little bit of corn syrup and waited an hour and tested again and it was at 55. Better, but I'm still scared. I feel like since his levels are so low I should be skipping doses??? What is the normal procedure when they are that low? I'm not sure what to do about the AM dosage, I unfortunately have to be up at 4am for work and so my boyfriend will administer the shot, so I will have him test him beforehand and see where his level is. If it's still super low, do I just skip the dosage? HELP!
Thanks!!!!
Ashley

 

I am no expert but I too would be worried with those numbers. I have heard people here say that they don't shoot if pre-shot BG levels are below 150... Can an expert chime in?

PS - I have skipped the last three shots for my cat, as his BG numbers were good (100 give or take)....

 

ok, first, let's address tonight's situation. exactly how many hours has it been since the shot was given tonight? i ask because syrup is a temporary fix. it will take the BG up but it's like us eating a candy bar. the effects wear off. sooooo, if it's still early in the insulin cycle, the BG (blood glucose) could drop again and you will need to intervene with some more syrup and/or food.

next, ALWAYS test before giving a shot of insulin and if the BG is less than 150, do NOT shoot any insulin. it is totally possible and very common for diabetic cats to go into remission and it's possible what has happened here. infections raise BG levels so it's possible that clearing the infection and a few days of insulin has put kitty into remission.

let us know about how long it's been since the shot and then we'll advise further. it is likely if it's been less than 6 hours that you will need to do a bit more testing tonight than usual, to save kitty.

i am having a family health situation at the moment so may be in and out but i'm sure others will be here too

 

Yeah, I wish I would have known that if he fell under a certain level to not administer insulin... of course, my vet didn't say a word of that! Ugh. I feel completely paranoid tonight, I am checking up on him every 20 minutes to make sure he is still waking up and breathing. His last shot was at 5:45pm, I am planning on staying up with him for the next few hours and checking his levels, giving more syrup etc. I'm just not sure when the insulin starts to wear off. I am absolutely NOT giving him any in the morning, I will test him when I wake up and make sure he is ok. I'm just wondering when I can stop worrying... I know the insulin acts right away but not sure when it starts to get out of his system. I waited an hour and just tested him again, he jumped to 55 after the syrup and is now back in the 30s, so I understand what you are saying. I just gave him a little bit more so I will check him again in another hour. Thanks for your help!
P.S. I'm sorry about your family health issue I hope everything will be ok!!!

 

ok, ProZinc will kick in within 1-2 hours after the shot and work normally for 6-8 hours, then it starts to poop out soooooo, i think i'm figuring that it's been about 2.5 hours or so from the shot? that means you have a ways to go.

we don't like to see numbers under 40 early in the cycle, in other words, before that 6-8 hour mark. a 40 10 hours isn't such a concern in that it requires syrup but that would mean the dose may be too high but we can get into that stuff later. for now we'd like to get your kitty up possibly into the 60's-70's and not to go back lower than that.

tomorrow morning you are likely to see much higher numbers, from the syrup and rebound from these low numbers but you stick with the plan and don't give insulin. you can always post here first and see what others say. kitty's body will possibly take a day or so to clear his system of what we're doing tonight (aka: intervening with the sugar). sometimes people see high numbers the next day, shoot more insulin, and end up with even worse situations or they keep kitty on an awful rollercoaster for days

 

Just to make sure - Are you using U40 insulin syringes with ProZinc? ProZinc is a U40 insulin and you use U40 insulin syringes.

If you are using U40 insulin syringes, how are you measuring 0.5 units? That is, what line are you drawing the insulin up to? U40 insulin syringes aren't available with half unit markings. Are you measuring up to the line marked as 5, which is actually 5 units not 0.5 units. Or are you just eyeballing just under the 1 unit line to get 0.5 units?

Some people do use U100 insulin syringes instead with U40 insulins so they can better measure smaller doses. A conversion chart must be used so that your cat is getting the right dose of insulin, http://felinediabetes.com/insulin-conversions.htm

 

With the blood sugar numbers you mention, the diabetes may be TRANSIENT or short term, secondary to the infection.

So after the infection is cleared up - BINGO - no more diabetes.

SO.... do not inject insulin if your kitty's blood sugar is below 200

Many newly diagnosed diabetics have blood sugar over 500, so 300 is not too bad.

 

Hey Ashley!

Just checking in with you guys. I'm glad to see you made it to FDMB and welcome. You have several people with PZI expertise who are providing very good guidance. No doubt, clearing the infection and getting Hagrid on a low carb, canned food diet is contributing to lowering his insulin needs.

(Hagrid is my civie, Gizmo's "uncle" -- sort of. He's a big, beautiful Norwegian Forest Cat!)

 

HHey there! Well it was a long night (with very little sleep), Here is the list of how his levels went last night:
5:19pm-39mg/dL
6:43pm-55mg/dL
7:47pm-35mg/dL
9:21pm-121mg/dL
Midnight-47mg/dL
4:28am-39mg/dL
3:35pm-45mg/dL
So that was the last time I checked him. And I just tried to feed him some FF gravy with turkey and some corn syrup on it, and he ate for about 2 minutes and that was it. He has been eating really really well, so I can't explain why he didn't chow down, unless it's because he isn't feeling well? His nose is still a bit pale. I don't really know what to do at this point besides continue to test him and see what happens. As we speak he is up running around with the kitten. So he can't be feeling TOO bad. I don't know what to do about his PM dosage either... like I said, I skipped his AM dose, so I don't know if that's what I should continue to do until his levels start to raise. Any suggestions?? It's been almost 12 hours since his last dose. I would think his levels should be raising by now, and that scares me that they aren't.
As for the syringes I am using, they are U40's... so when I first took Hagrid home from the vet, she told me to eyeball .5 units and go from there.
Thanks again for all the input everyone! It really means a lot!

 

Ashley, your Hagrid is gorgeous! As for shooting insulin.......I definitely would not shoot until you see a good 200 on the meter. He may not want to eat if you've been giving him food every so many hours along with the syrup. Don't worry about not giving the insulin just because you skipped a shot........you have no way right now of knowing if he has gone quickly into remission and/or if the infection raised his bg numbers and now they are back down into normal range. Going to be a wait and see situation and yes, some cats can quickly go off insulin like that.

 

These are great numbers for no insulin. They are normal numbers for a nondiabetic cat. I am curious when he ate during that cycle. If he ate when he was higher, and then went lower, food is bringing down his blood glucose levels. It looks like your kitty might just be off insulin!

Continue to take bg levels in the morning and evening. If you get a number in the 200s come back on for advice.

So fantastic you were hometesting and caught this.

 

hey there! been wondering what happened with last night.

almost 24 hours since the last shot though right, not 12? if so, you don't have to worry about his numbers at this point and syrup. the insulin should be out of his system at this point.

do you have any other kitties in the house? if so, test one of them and see what you get. my non-diabetics run from the 40's to the 60's.

i'm thinking there's a possibility that Hagrid either wasn't diabetic to begin with or that he was borderline and the infection sent him over the edge? either way, with the numbers you are getting, you definitely don't want to shoot insulin.

now, let me get this straight, you know Sienne? if so then we probably don't need to discuss proper diet and all that other gobbly gook about keeping Hagrid on low carb food so as to keep the diabetes away?

 

Cindy --

Feel free to review issues around diet, dosing, etc. Between Ashley's schedule and mine, it's hard for us to connect directly. Since I'm a Lantus user, I'm far less conversant with PZI/ProZinc. I also think it will be easier if all of the info is in one place. I'm just very glad that Ashley started home testing when she did or this could have gotten very ugly, very quickly.

Ashley -- remember, if there's no insulin on board, there's no chance of a hypoglycemic crisis. It's looking like Hagrid may be making giant steps toward being diet controlled. Get a test in at your usual shot time and then before you go to bed.

I suspect that Hagrid will need a dose reduction if his numbers head back up. Do the ProZinc users have any thoughts about what dose Ashley should be shooting? She has an early AMPS and it's possible that no one will be around.

 

You all really are wonderful! I feel so much more comfortable with the loads of info I am getting from you!
Thanks for the compliment Hope! That is of course a pre-diabetic picture He was a big boy at that time.

Cindy -- Yes, 24 hours is what I meant.. Now you can see how tired I am. I work early and long hours and then go to school as well so I don't seem to get much sleep as it is nowadays, and add a sick kitty on top of that and I feel like my head is spinning. I do have 2 other boys in the house, one is the same breed as Hagrid, and the other I adopted from a shelter. I actually did test Gunny (a big healthy boy who is a year younger than Hagrid) last night, his number was 56. It's really strange to think that Hagrid may not be diabetic now. The way it started was he got real sick and I noticed blood in his urine and found out he had crystals, so he had those surgically removed. Then he was on antibiotics for that for a while. A few months after that is when I noticed him standing at the water bowl all the time, the severe weight loss, extreme amounts of urine in the litter box, big appetite but wouldn't eat much.. etc. I took him in the vet a few times at this point and the first time they did blood work and everything looked fine, I waited... took him in again because it was getting worse and I basically walked into the vet saying "My cat is diabetic, test him now." They did, and they said it came out positive right away. And the next day is when we started insulin.

The hypoglycemia freaks me out. Just to ease my mind, is there any way he could have that right now? I have read the symptoms and he's obviously not showing anything severe besides having a low bg. So now it's been over 24 hours since having a shot.. I tested him at 5pm and he was at 89 and I just tested him now and he's back to 40. And I know the peaks of high numbers has to do with the syrup. Would it be safe to stop the syrup intake now that he has no insulin running his system?

Sue -- He has been on a diet of Fancy Feast Gravy, when he gets sick of that and won't eat at all I will give him some stage 2 chicken baby food and since I have other boys who eat hard food, I took away the icky dry food and replaced it with a no grain dry food. All of them seem to love it!!

Another real quick question, does anyone know anything about why his nose is so pale? It is almost white! It's kinda starting to freak me out a bit because usually he is a slight pink. Don't know if I should be concerned about that or not. I just want my old Hagrid back I want him to put back on all the weight he lost and just feel better.

 

Yes, you need to stop the syrup. That is probably why you are seeing the swings up to 100. He can not hypo if he is not on insulin. IMHO, you have a non diabetic cat!

Sorry, don't know about the white nose....

 

agree with Sue. no more syrup. no need for it at this point since he hasn't had insulin in over 24 hours now. the swings are probably a combination of the syrup and his pancreas doing some work. just as we have fluctuations thru out the day in our blood sugar, so will kitty.

as far as the nose goes, I can't say for certain. i have a few who's noses go from completely white to bright pink depending on what they are doing, what time of day, and if it bothers me too much and i rub their little noses which pinks them back up. i have a baby boy that we captured a few months ago out back who unfortunately was born with a bad heart who's nose does this. his always catches my eye when it's pale because "pinking up" is one of the things the vet checks when he's in for a visit so when i see his whiten up i also check his gums and poke at him to see if he pinks up

i have another boy, about 5 years old, who everyone here knows as my "special" boy because he was pulled out of a car engine and had a very serious head injury from it and he's just not ummmmmm, let's see how i should put this.....let's just say he's not always playing with a full deck :lol: anyhow, his does this too.....his tends to be whiter when he's sitting still so maybe it's just a circulation thing?

 

Mp additional advice here...you are getting good advice already.

Just wanted to welcome you and say that your kitty is absolutely stunning.

And he will get well and be stunning again.

 

Just to put all of the food info in one place...

For info on diet and feline nutrition, the website by Lisa Pierson, DVM is excellent. She discusses diabetes as well as other issues regarding UTIs and crystals. Be forewarned, especially for cats with urinary track issues and diabetes, she's not a fan of dry food. The dry is dehydrating which is the opposite of what you want for a cat with crystals and UTIs.

Janet & Binky's food charts are the go to here for information on carbohydrate content of food. Low carb food, what you want to be giving a diabetic cat, is under 10%. We use the gravy varieties (marinated and grilled Fancy Feast, for example) which are usually high carb (over 16%) to steer numbers when they run low. Most people here transition their cats off of dry food and on to canned. Low carb food is not a problem for your other kitties. Gizmo and Gabby eat the same food. (I feed a combination of raw and Wellness although I just moved the canned from Fancy Feast to Wellness). They get food that is in the 4 - 5% carb range.

Hagrid may be fine to eat up to the 10% range. Once you stop the syrup, get in a few tests to see where his numbers stabilize at. His numbers may have been bouncing around a bit and will even out once the high carb is out of his system. There are also some cats whose normal BG levels are in the 40s and 50s. As long as he's asymptomatic, I wouldn't worry. Also, you can feed him as much as he wants until he's back up to his healthy weight. Diabetes is a starving disease. The high BG when he was sick suggests that nutrients were not getting into his cells which basically means he was starving. At this point, let him eat whenever he wants as long as it's low carb. (The baby food is probably around 7% carb due to the corn starch content.)

If Hagrid's numbers are staying in a normal range, that's under 120, he probably was pre-diabetic and the UTI pushed him over the edge. What that tells you is you have a means of knowing if he's getting sick -- test him. If his numbers are heading up, get him in to see your vet. he may have an infection brewing or need a dental. For most of our cats, any infection or inflammation raises BG levels.

I'm not sure how the ProZinc folks decide when a kitty is diet controlled. We have a an OTJ ("off the juice") series of steps we use on the Lantus board. This involves testing at shot time but not giving insulin for a period of 2 weeks. (You can test more but at minimum, you want to test twice a day, 12-hours apart.) If numbers are higher than is desirable, give some food, test in 3 - 4 hours and see if Hagrid's numbers come back down. If they do, Hagrid's pancreas is working. We also encourage multiple small meals throughout the day. It's easier on the pancreas. After 2 weeks of carefully watching and no insulin, Hagrid would be "officially" off the juice and diet controlled.

 

It is 12AM and Hagrid is playing fetch with me with his milk jug ring.... which he hasn't done in MONTHS!!! Just wanted to document that....

 

yeahhhhhhhhhhhhhhhhhhhhhh

 

I tested him this afternoon and he was at 123. Shoot or not shoot?? He is acting like he is feeling like a million bucks!

 

no, i wouldn't shoot insulin. i'd feed a small bit of food and re-test in an hour

 

See where he is an hour but it could take 2 or 3 for numbers to come down. When did you feed in relation to the last test and what did you feed? You may be seeing a food spike.

Gizmo plays fetch with his springs!!

 

Hello again!! Sorry I haven't posted in a while, I have come down with a nasty cold and I barely had enough energy to keep my eyes open the past few days. I have been testing Hagrid about twice a day the past few days and his numbers are staying consistent in the upper 40's to 50's ... with NO insulin injected at all. So I guess we are on the up and up with that! I of course am still being cautious with him and keeping a very close eye on him to see if I notice any changes in his behavior, but so far so good! I'm glad he is feeling better. Thank you guys so much for all of your help. If it weren't for you all, things probably would have went downhill for him, so I really appreciate all of your advice!
Hope all is well with you and your kitties!

 

Fantastic news!

about Hagrid, not your cold.

hope you are feeling well soon.