On-going hypoglycemia???

Last night I gave Sarah 3 units of Lantus at around 9 pm. Her +1 BG was 30, and she spent the night at the emergency vet. Treatment was:

+2 hour (admission to vet): BG = 43, started on 5% dextrose +fluids IV
+4: BG = 56, continue on 5% dextrose
+7: BG = 156, switched to 2.5% dextrose
+10: BG = 65, switched back to 5% dextrose
+12: BG = 89, picked up from vet
+15: BG = 76
+19: BG = 30

I brought her home and she ate a bunch of dry cat food and took a nap. Despite the food, her most recent reading is back down to 30--even though it's been almost 20 hours since her last insulin dose.

What do I do? She's still eating and is quiet but not displaying any other signs of hypoglycemia (last night she wasn't eating at all). I do have some of that rapid glucose gel for diabetics, but I'm worried that if I give her that, her pancreas might rebound even more. Does anyone have any idea what's going on? My vet is stumped--if she keeps this up, he wants her in tomorrow to check for an insulinoma.

BG chart: https://spreadsheets.google.com/ccc?key ... NZmc&hl=en

 

Hi....I know it is scary....you are not alone.
An overdose of a longer lasting insulin like lantus can cause a longer duration of low levels than normal.

The liver is not kicking out the rebound hormones needed, possibly because it has been battling low numbers prior to the crash with this last dose.

I encourage you to keep feeding little amounts of food, offer some high carb, mixed with a little karo.
food with gravy on it? wet high calorie food?

The dextrose worked at the vets to bring levels up, but it does not last in the system, so now you need to balance food and karo..
the karo will work immediately to bring levels up, but then fades, the food takes about 20 minutes but lasts longer.

test about every 20 minutes and you will simply need to keep this up until the insulin is fully out of the system.

I am sorry you are going through this, but it has been seen before so don't despair. Just keep on snack, test, mix with karo if not above 45.

You need to see three rising levels above 70 before truly relaxing

If this does not turn around in the next 60 minutes or so, I would seriously consider taking kitty to a 24 hours emergency facility and have them monitor. Low levels even without symptoms, can cause problems.

 

Thanks, Sweetgrass. My vet doesn't have any experience with Lantus (I'm his only client using it). How long could it take for the Lantus to stop acting? I'm glad she at least has an appetite tonight--I just ran out to the store and bought her a whole bunch of different flavors. Right now she's working on a can of tuna.

 

Tuna is low carbs, try and find some beef or chicken with gravy?

Don't let her eat too much of the tuna kay? you ned the higher carb stuff. Posting this and then typing more

 

can you mix just a little syrup in that tuna? we need to get her BG up some and plain tuna won't do it. putting a little syrup will. also, don't let her eat so much as to get full. we may need to keep her eating for a few hours so teaspoons at a time

 

Okay..I have crossposted this on lantus Insulin support as well, as I know there are others that have had extended lows, but how long , I can not answer for sure.
You would think it is heading out now, but the fact that levels dropped again is worrying.

How long has it been since she ate the dry food?

 

Hi, I'm a long time lantus user, but don't post a whole lot.

I haven't dealt with this long of a hypo situation before and am not going to tell you how long I think it may last. I would encourage you though to try to feed some high carb wet food-something with gravy in and continue to check bg's at least every 1/2 hour. You said you're not seeing obvious signs of hypo which is good. Hopefully this will pass soon.

 

it's been about 1/2 hour since your first post. can you get a new number for us??

 

She's been eating dry on and off all day, but hasn't had any for a few hours. I just pulled the tuna and replaced it with beef, but she didn't want much of it.

Working on a new number--she's hiding under the bed right now and I can't reach her.

 

bring the tuna back out if it will lure her out from under the bed maybe???

with BG 's this low she can't be hiding. easier said than done i know but don't worry, we're here with you

 

Sarah - do you have any high carb wet food and some food with gravy? What is the latest BG? You will want to test about every 15 monutes until you see some steady increases.

 

OKay I see you got a 45. Continue to test every 15 minutes and try to feed 1 tsp at a time of gravy or high carb food.

 

Yup, agree...load the tuna with karo and get her to work that...if you can't get her to eat, you will need to rub karo directly onto her gums and get it in asap.

I know it sucks, perhaps have her in the bathroom with you so she can not. You have to act for her to keep the levels up now.
as soon as you get some food/karo in, try and get another test okay?

 

She just tested at 42. I smeared a little of the glucose gel on her lips ("tropical fruit" flavor is not popular with cats!), and now she's licking a little at some beef food. How long is this going to go on??? We're approaching 24 hours without insulin--shouldn't she be starting to improve?

 

Good job..the karo will bring levels up so she is interested in food, and the food will help keep her levels up.

Hang in there..there is not timeline, But it is coming up and you are making the difference here.

 

dry food takes longer to send sugar into the bloodstream, wet works faster.

tuna foods are typically not high carb - you need something with gravy, and gravy is where most of the carbs will be.

karo, honey, sugars like that will only help temporarily, foods are better, but you don't want her to get too full and stop eating until you're at a safe number.

lantus, being slower-acting, works on a "shed", so the last dose is probably still in her system and may take several cycles to clear out.

someone else will need to help you with a new dose, looks like 3.0 is too much for your baby.

you're already getting some great guidance here, just keep testing and feeding small amounts of higher-carb wet foods.

 

the 42 is pretyt much the same as 45 so you're gonna have to keep at it. i myself would like to see a 60 or slightly higher and holding there

 

do you have or can anyone go get any of these foods?

Fancy Feast brand

Flavors:

Grilled Beef Feast
Grilled Chicken Feast
Grilled Turkey Feast
Minced Beef Feast
Minced Turkey Feast
Sliced Beef Feast
Sliced Salmon & Chicken Feast

They are all 17-18% carbs and are really good at bringing up BG levels

 

BG = 45, gave a little more glucose gel and as much beef wet food as she wanted. Dry food is out (many flavors), but she doesn't want it.

 

come on kitty! throw me a 60! still waiting here with you. not going anywhere

 

She doesn't like Fancy Feast, so I have a bunch of Friskies and 9 Lives out for her. She's working on the beef 9 Lives right now.

I'm trying to get those numbers up! At least she's still eating.

So could this go on for days? I took today off to take care of her, but I have to go back to work tomorrow. If she's still having trouble, that means going on a dextrose drip at the vet (because she won't eat while she's there).

 

Hi, I don't think you will need to worry about tomorrow. The food has brought her up from the 30 and that was worrying. She may hang between this and 70 for awhile, but you are doing great. let's get through the next couple of hours and see where you guys are at.

Not eating at the vet is probably the reason you had that drop again along with the extended duration. Food and glucose is needed to really make a lasting difference.

Hang in there.....
feed a little, test a little, check in a little...we are all here cheering you on.

Now as to future dosing...I would really encourage you to also post in the lantus insulin support group and get some experienced ideas before giving anymore insulin.

What you know for sure, 3 units is way too much.
Waiting for news and a test

 

hang in there Sarah! You're getting a really quick initiation but you're not the first person this has happened to. You're in great hands.

In answer to your questions about how long this will go on, we really can't tell yet. Probably not days, definitely hours but we can't tell how many. You're doing great, the secret is small amounts of food every time the number starts to wobble downward, and keep testing.

One thing is for sure, your cat does not need 3 units of Lantus! How long has she been on that dose? Was this the first time? Sorry, I just got home and haven't caught up on your history yet.

 

hi there! heard on the grapevine that you were having a tough time. yes, what was posted before, that this can continue for a long time, is true but you are doing great. the night is young and hopefully her natural defenses will be able to overcome the insulin OD soon and you'll get to bed at a decent hour.
keep doing as you have been little bits of food often, with as much carbs or sugar as you can until we get 3 tests of rising numbers. enough hours have gone by that the threat of severe hypo symptoms has waned, just want to get those numbers up into a more comfortable range. they will 'bobble' a bit, go up from the carbs/sugar, then drop back down as that wears off and the real action of the insulin is seen again. but you are in control, and doing a great job and this will pass eventually. hopefully next test will be the start a of nice rise.....

~jojo

ps. you will not be giving her a shot in the morning even if BG is high, okay? we'll see how things are tomorrow and see how much if any lantus she needs tomorrow night, but is will not be anything close to 3 units, more like 0.5 units. this long low number action she is having points to 3 units being far far above needed dose.
pss. she does not need to be tested for an insulinoma, this is normal response of a lantus OD.

 

Now she's up to 374?!!! I'm glad she's not hypo anymore, but what's going on?

 

Oh good news indeed now

That is her body ( liver ) finally kicking in and reacting to the low levels by sending its own sugars out to bring up the levels.
This will raise overall levels and create some really wonky readings for a couple of days..however, you do not want to dose because of these temporarilly inflated numbers. They will settle again.

I would wait and get feedback from lantus users n how to proceed but I personally would give the body the evening to rest following this, get a good night sleep, and start fresh in the morning.

Well done, you really made a difference for your kitty tonight.
I am going to remove the 911 from your post now.

((((hugs))))

 

that's a good thing, it means your immediate crisis is over. GREAT job!!!!! The high number is her body's response to the low number - it basically sensed that the blood sugar was too low and sent more sugar into the bloodstream to compensate and keep her safe. That number will come down on its own, and we need to just give it some time to see how things settle out. Jojo said no insulin tonight or tomorrow morning. I would grab a couple more tests tonight and tomorrow just to see how things are going - please do post your numbers because I guarantee lots of people are watching for your good updates! Then post here (or even better, come find us in the Lantus group) before you give any insulin tomorrow evening.

 

Thanks for your help! Sarah and I are looking forward to being able to sleep tonight--we've both had a very long two days. I'm definitely going to lay off the insulin until she stops bouncing around.

I'm assuming at least some of this is the 5 cc of glucose gel that I syringed into her mouth a few hours ago. How long will that keep her BG high, and should I expect her to go hypo again?

 

just got home and first thing i checked was this thread. so glad to see that number. higher for a little bit is always better than too low at all.

and i have to agree with what the others suggest, give her body a break, it's been thru hell these last 24 hours or so, let it settle down some and sort itself out a little and tomorrow night, see if she's high enough for a shot and if so, start over at a lower dose and if the need is there for more, then raise the dose very gradually so you don't have any more days like this last couple have been for you.

 

oh great news! i would wait an hour and then get another test and see how much of that number is the glucose you gave and how much is her body taking over control of this situation. if number still up there then go to sleep, sure you could use the rest after all this stress. if number drops big time then will need to take action again to get it back up, but really i think she is running show now and insulin has petered out.
and yeah for sure no insulin here at all tonight even if that number is way way higher at the recheck in an hour.
her body has been working hard to fight the insulin for a long time so she just needs some time to rest and tomorrow can see where the BG is and formulate a plan.
if you need something to do to kill the next hour, maybe wander over to lantus ISG and read the stickies at top of page, a lot of info there that can help you. start a thread and introduce yourself or just lurk around.

glad this is winding to a close. see ya in an hour for the recheck and then hopefully will be bed time. :smile:

 

She's down to 118 ... now I'm worried. Is she going to crash again?

 

no she is not going to crash again because you know what to do. go ahead and load her up again with more high carb food and sugar. okay not bed time yet, sorry. going to have to get a couple more spot checks. but this 118 is a safe number, very safe. just going to bump it up because it is so much lower than last spot check.
so go ahead and feed her and recheck in 1/2 hour, will wait for your recheck, k?

 

As Jojo said, not quite bedtime, but not panic time either ((hugs)) will be up with you checking in for awhile. It is only 9:00pm here.

 

I'm tired ... I've been up for two days! She's eating some 9 Lives wet right now (not showing any interest in the dry food, unfortunately, though I've offered her 5 different types), and I'll re-check in a bit.

 

Awwww I imagine you must be exhausted. Can you set an alarm in case you fall asleep that will wake you to test?

 

We're at 102 now. Am I safe for the night or should I stay up?

My first reading this time was 413--and then I realized that some of the glucose gel from earlier had ended up on her ear.

 

oh darn, wonder if some of the glucose gel was on ear for that 300 something reading before? that number was awfully high and the dip after was more than i expected. if we knew that the 300 something was a false reading and there was not that big dip then things are not as tense.

well number is holding, 118 to 102 is not a big dip. she is just eating regular wet food, not high carb stuff? you can mix some karo or something in that to push number up more so that you have more of a safety net so that you can get to bed sooner. they don't seem to mind taste ever of karo or honey mixed into food.

 

I'm now thinking the high readings were false--they came out of the same ear as the most recent high reading, while the other lower readings were from the other ear. Unless one ear has diabetes and the other doesn't

She won't eat anything doctored (I've had to mix too many weird things into her food over the last 7 months), so I'll give her a little glucose gel by syringe and then take a nap.

 

lol, well since i've never seen a cat with just a diabetic ear, yeah sounds plausible that the other high reading was false.
okay sure go ahead and give her that and set the alarm to get up and retest. hopefully you'll wake up from your nap to a nice solid number higher than these and then can go get some real sleep. just leave out food for her when you finally do go to sleep for night.

suggest posting in lantus ISG with your wake up BG number. everyone knows that you will not be giving insulin in the morning but still need those BG tests to see what is going to be a good plan. and make sure you call your vet and let them know an update, hopefully they will have looked some stuff up and will know that this is normal for a lantus OD and not pursue the thought of testing for insulinoma further.

have a good nap. you did a really great job here today!

 

Sounds like a good plan....

I am up for another 90 minutes or so and will check back. Should ( antijinx) anything happen, do start a new thread and shout what you need from it okay? Otherwise if things are smooth and mellow, this thread to continue on is fine.

 

Thanks for your help!

 

Looked good last night, yay!

 

Wow, coming in late here and I hope you both are having a great sleep in!

Gotta say I laughed at the glucose on the ear thing; in all my years here I have never seen THAT happen

Will look for your updates

Jen