think my cat has had his first hypo, vet disagrees

I'm in the uk and Fudge is a 13 year old neutered male who was diagnosed diabetic in march this year. After many blood tests and changes of insulin dose, his last fructosamine test showed his diabetes is under good to tight control. He is on 4 units of caninsulin twice a day.
So all seemed well until today. He had his insulin jab this morning at 8am as normal after he had eaten a little of his food (he is a grazer and never eats all his food at once) Both my husband and me were in and out most of the morning and early afternoon, but when we returned at about half 2 fudge came in and started to act really oddly. He was walking around the edge of the room and sniffing the walls. If anything was in his path he climbed over it instead of walking around it. When we approached him it was like he wasn't really aware of us and not looking up when we called his name. I was straight on the internet as i recalled that pacing and restlessness could be an early sign of a hypo. We offered him his normal wet food and even a few of his biscuits but it was like he didn't even notice the food let alone smell it. This behaviour continued for half an hour and all the advice on the web seemed to say get some sugar into him just in case. We gave him honey, about a teaspoonfull over about 20 minutes or so and rang the vet. Well, being a saturday afternoon our vet was closed so we ended up talking to a central vet surgery who covers the weekends and evenings/night. He seemed to think his symptoms could mean lots of different things and honey may not have been the right thing. But to watch fudge for half an hour and if it was a hypo the honey would make a difference and his symptoms would lessen. 40 minutes later and fudge was still pacing so we took him to the vet. He gave him a full examination and did a blood glucose test and a urine test. Fudge's blood glucose was 4 which the vet said was low but not low enough to cause a hypo. He also did a blood test to make sure there wasn't an underlying infection. all test were normal levels. He said it could be the beginning of dementia. He said we should take him home and not give him insulin this evening but if he eats today and in the morning, to give him his insulin in the morning but miss out tomorrow evenings insulin and take him to our usual vet on monday. We came home and fudge continued to pace around but ate some of his normal food, little and often over an hour or so and soon returned to his normal self. So we think the vet was wrong and it was a mild hypo. The blood glucose test he did could have been at 4 because of the honey or stress couldn't it? Also did a urine test at home 4 hours after fudge started pacing and it was only 2. Was this vet wrong do you think?

 

Yes, it sure sounds like a hypo. And with some very scary symptoms. The honey and stress could have raised his bg levels when taken at the vet.

You MUST test at home. It sounds like your kitty is going to be needing less insulin, and you will need to know what his blood glucose levels are, before every shot. We use human glucometers and test before every shot and during the cycle, so we know what the insulin is doing. Here is a good beginning info site: http://www.sugarcats.net/sites/harry/bgtest.htm and a video: http://www.youtube.com/watch?v=_zE12-4fVn8

We figure that we would test our children, not just blindly give an amount the doctor told us a week before. So we do the same for our cats. Many kitties have avoided a dangerous hypo here, by hometesting. We would love to help you learn how.

 

I'm assuming the 4 is in mmol/L right? Many of us speak in mg/dl, which would be 72. That is on the low side, but that number alone probably wouldn't cause symptoms.
Honey will cause a short increase, but won't last that long.
Have you considered learning how to test Fudge at home yourself? That way there will be no doubt if it is a hypo.

 

Thanks. I knew someone would say we need to test fudge's glucose levels at home. This seems to be the the only way of knowing for sure that he is getting the right insulin dose. It is not something our normal vet has ever suggested and i know i need to discuss it with her. It is reassuring to know that my instincts were right and that fudge's symptoms were some kind of hypoglycaemic episode. I have never seen him act like that before and though i realise it could have been much worse it was still pretty scary

 

Well, add some honey, possibly some stress going to the vet, and that could account for the 72 reading . Please, hometest ASAP. You were lucky today that you were home and caught it. Definitely hypo....especially the sniffing all around and not reacting to you. Been there, done that. I certainly would not shoot insulin tonight and hopefully you will get a meter in the a.m. and start testing. Your kittys life depends on it now.

 

If I were you, I would not wait for my vet's permission. You do not need it. You can test at home and fax your vet the numbers.

You need to know what the numbers are before you give the next dose. A hypo often causes a cycle of low numbers, sometimes after one high number if the cat has been given high carb food, syrup or honey.

 

yes, i'm using the uk measurement. As you can imagine i am feeling pretty apprehensive about giving him any insulin tomorrow. My normal vet always says 'if in doubt. don't" so i'm inclined to follow her advice as i'm not home testing, though I am certainly considering it. I am grateful to you both for replying.

 

thanks to you too Hope

 

I think today proved how important hometesting is. The 4 was the honey and stress. The symptoms you described could have been other things and the emergency vets are correct to check all things, but you have a diabetic cat and after some time and food he's back to his normal self, so I would say classic hypo occured.

If this were my cat, I'd get the glucometer from the drug store, start hometesting before I give another shot, but also think about what dose you want to give going forward. 4U would be something I'd reconsider. Once you start to hometest you can start lower and work your way up, if you need to, based on the blood glucose. The fructosamene test will tell you over all how your cat has been over a few weeks, the urine will tell you how your cat was overall over a few hours or more, the glucometer will tell you how your cat is at that exact moment in time. It's much safer to make insulin dose decisions based on real time numbers.

Great catch today and I truly believed you saved your cat's life. You have a very lucky kitty

 

thanks tuckers mum. i know all of you are right about home testing. I don't want to put my cat or us through this again

 

Hi and welcome to FDMB :mrgreen:

Like the others, sounds like hypo to me.
My guess is 4u over best part of 6 months has sent Fudge into rebound.This is where the dose of insulin is too high.Cats have a lie saving response that means they can release glucagon into their bloodstream and this raises the bg.You then get a cycle of this continuing to happen. However after a time (and this will vary cat to cat)this effectively 'gives out' and a hypo results. You've done well to catch it.

Please go to the Caninsulin isg and (click on insulin support groups) and read the stickie about Caninsulin.
This is by all intents and purposes an outdated insulin now.A lot of UK vets seem woefully out of date about Feline diabetes, but then think of how many animals and how many diseases they treat and you can understand why. FD is on a rapid increase, mainly because of dry food (really pushed commercially).Dry food can have as much as 60% carbs in. This is just flooding cats bloodstream with glucose and eventually overwhelms pancreas and damages/kills the beta cells which produce insulin (think of obesity in humans).
What can be different is the chance of having a cat with type 2.If they do (and unfortunately there is no way of knowing)they have a chance of going into remision and becoming diet controlled.Only time will tell.

Don't be freaked by what has hapened.You did the right thing giving honey.Caninsulin peaks (when you get lowest bg number) around +3-5 hours after insulin, so could easily account for how you got a 72, which is still a low number, especially on this insulin.

There has been a ot of research in America/Germany/Australia into FD and 2 insulins in particular have been found to have amazing reults.Lantus and Levemir. The bad news is, your unlikely to get your vet to prescribe it in the UK as they are both human insulins. I was very fortunate here in Germany getting an army vet to prescribe the Levemir.
However, all is not lost There is a new insulin on the market in the UK called Prozinc.This has been developed for cats and is available in the UK.We have had a number of poepl start to use it and some good feedback.
Caninsulin in America is sold under the trade name Vetsulin. Same insulin.The manufacturer put out a warning last year to tell vets to transition cats to alternative insulins because there is something wrong with it's action. It stands to reason that Caninsulin may have the same problem, yet neither vets or anywhere else on the net is there anything to say Caninsulin isn't safe.UK vets that have been asked have stated they have heard nothing about it.Also, will often find vets don't like to think abunch of lay people off the internet know more about treating FD than they do. They will sel you prescripotion food-which isn't very good (M/D, W/D etc)

You need to firstly try hometesting.It is a lifesaver-humans wouldn't inject themselves without knowing what their bg was.Why shoud a cat?
You can either get a glucometer (One touch or accu check are good ones) from Boots/Llloyds or get one from ebay (will take a few days)

Once you have this, need to completely dump the dry and just give a low carb wet food.If you look through this thread to dbg, another UK newbie, I posted a variety of commercially available foods in the UK that you can try.
viewtopic.php?f=28&t=24708
4u is too much, but your cat may still need insulin before you see vet.Another condition you need to watch out for is keytones. These can be potentially life threatening and one of their causes is not enough insulin (it's a balancing act).
Again try Boots/Lloyds for keto Diastix (test keytones and glucose. ketostix only test glucose).These are urine testing strips. Just dip under pee stream and get a colour which you match for resluts. If can't get from pharmacy, again ebay.

I wouldn't give more than 2u until you've seen vet. However (and I know I'm just a name on an internet site, whereas you know your vet)they may say 4u is right because Fudge's bg is way high. This can be rebound (takes up to 72 hours to clear) and/or the fact that Caninsulin is an intermediate acting insulin that runs out after +10 (10 hours after shot), unlike a lot of other insulins.
This is why hometesting is going to be the only way you know exactly what's going on.
I would talk to vet about changing insulin, hometesting (you don't need their permission, but good to get them on board and it's rubbish that you need the alphatrack-animal glucometer that is expensive as are the strips. 99% of people on here use human one and is absolutely fine)and cut back on dose and start over.Then also once hometesting cut out the dry.

Just to explain-reason I'm not saying cut dry immediately is because of the 4u your on. That dry could be the only thing that is keeping his bg's up because of the carb content. The lower amount of carbs you give anyone, the less insulin needed to counteract the glucose (cos it's less glucose to work on )

Think that's heck of an essay I've given you here.
Take your time
Don't panic
Keep asking questions
It can be a leap of faith trusting here and you must always ultimately go with your gut. You can see Fudge, we can't you know your vet etc etc, but we are here to offer help/support (we all pay forward the help/support/knowledge we have received.Just make sure people have experience of Caninsulin before taking any dosing advice. Different insulins use slightly different treatment protocols-hypos however are the same!!! Just how long they can go on for that might vary)
Good luck and scritches to Fudge cat_pet_icon

Btw-I'm UK but presently live in Germany.

 

Home testing is very important. Humans would never think to give themselves insulin without testing first, and our cats are no different. I agree that you very likely saved your cat's life by your quick actions.

Now that 72 may not be all that low, but remember ... you watched the odd symptoms for a bit, you gave honey, you then got in to the vet. By the time you got to the vet, that 72 was a higher number, meaning it was very likely much lower when you first observed the odd symptoms.

So since it was likely a hypo situation, like many cats, yours could also be more sensitive to the insulin, so you are right to think about giving less. Someone suggested 2u? That's sounding like a pretty good idea because you can always give more, but can never take back too much!
Better and safer to give a lesser dose, at least until you are able to start home testing and know for sure of any low numbers. Many vets don't mention home testing; mine did not either, but I started and am glad I did. Just tonite, I tested at mid cycle and found my sleeping Shadoe was low, so I gave her some high carb food.

You will have less worry once you are home testing.

For the foods, the others are right for sure. That dry food is very high carb and likely causing higher BG numbers, so you would do well by removing all the dry food and replacing something like fresh chicken as the treats.

Good luck on the lesser dose and your start on testing.
And good catch on the hypo!

 

thanks to Kate and to Gayle

Fudge is eating royal canin urinary wet food as he has had urinary tract problem/cystitis and crystals over the last 6 years. He has maybe 10 to 20 urinary biscuits a day sprinkled on top of his wet food. So when he was diagnosed with diabetes we had a choice to move him to diabetic food and risk him having more urinary problems or leave him on his urinary diet and try to regulate him on that. We chose the latter.
We test his urine with keto-diastix for keytones which are not present.

I am sure we did the right thing yesterday, it is frustrating that the vet seemed to rule out a hypo so quickly and suggest it was dementia. I have decided not to give fudge any insulin until i see my usual vet on monday morning. I will talk to her about starting home blood testing.

As for the type of insulin, i will ask her about that too.

I really appreciate all your help

 

Hello, I am in the UK and also joined yesterday with pretty much the same problem. Have managed to do a couple of home tests and it is nowhere near as difficult as I thought it would be. Everyone is so helpful on here and I am so glad I have found the site.

My cat was behaving drunk and my vet refused to believe it was a hypo and said he had arthritic hips!! I resorted to home testing the other day as my gut told me different. Thank god I did as I was proved right in that my poor cat was definitely having a hypo. My cat was on 3 units twice a day of caninsulin but have dropped to 1U after that episode. Gonna keep testing and then go to the vet armed with results.

Gonna try and get my vet to switch me to prozinc as Kate suggested as I am pretty sure I wont get Nimbus regulated on the caninsulin.

Good luck with the home testing.

 

Oh my goodness! Dementia and arthritis! It's sad to hear what comes out of some vets' mouths.
Sorry, I know it's serious but my first thought when I read the vet said it was dementia, was whose got that? the vet?

I am glad you are both here and hope you two are able to sort out everything for your cats.