Wild BG spikes over past 36 hours, I can't stabilize

Hello all,

My 15.5 year cat India went to the vet's for a few days while we were away, where they gave her 2 IUs of insulin (Lantus Glargine) twice per day. The vet informed me she had a hypoglycemic episode; she gets very stressed at the vet, probably wasn't eating properly, and thus she came home a bit sluggish.

Since 12/31 I have not seen much improvement and her BG has not been stable. In the past 36 hours it dipped down to 16 and now is over 600. The cat seems to be suffering from hyperglycemia; very lethargic, meowing, and disoriented.

Here are her stats for the past 36 hours:

1/3/10 10:30 am 16 no shot
1/3/10 12:10 pm 317 no shot
1/3/10 2:27 pm 393 gave 1 IU
1/3/10 8:27 pm 265 no shot
1/4/10 8:00 am 585, gave 2 IU
1/4/10 6:00 pm over 600, gave 4 IU
1/4/10 7:28 pm over 600

She has had very little appetite but also has not slept much; during my waking hours she's usually been up as well.

I am hoping the insulin I gave her 90 minutes ago will kick in. I think she may also simply be fading out; her organs may simply not be able to continue. It's very upsetting to me; I can't let her suffer and will have to put her down if she continues to remain unstable. After her last expensive vet episode I agreed with my wife we could not engage in expensive vet treatments as we simply don't have the funds, unfortunately.

Not sure what else to do!

 

Hi there,

If she had a hypo, she is going to be reactionary to it. This is a major rebound and I am very very concerned about that 4 units she has onboard. Do you have Karo syrup or high carb canned food available?

I do want you to understand, she is anxious and lethargic due to the extreme swings in numbers she is having, not because she is sick, so put away the PTS thoughts you are having, she's going to be okay. She just needs some stability and she will return to normal, I promise. Lantus is not an insulin that you can adjust dose every cycle with. It builds up in the system.

I absolutely recommend that you reduce your dose to an absolute minimum for the duration, at 1u or maybe even 1/2u. You must watch her closely this cycle, and next due to the 4u she has on board. How long has she been diabetic and on insulin?

 

Hi, I share Carolyn's concern. Do you have the tools necessary to handle another hypoglycemic episode? Karo and higher-carb canned food are recommended. Please let us know what you have on hand so we know what you're working with.

 

Thanks, I do have Karo and Fancy Feast, plus Whiskas packets.

I am about to take another BG reading but things look pretty bad. India is basically sitting up but with her head propped at a weird angle and kind of croaking an acknowledgment whenever I approach her. The last two readings of her BG tonight were both above 600 (the glucometer doesn't even show the exact amount; just reads "HI" hopefully it will be readable this time.

I appreciate the advice about my euthanasia thoughts. It's such a difficult line to walk; trying to keep the cat alive and not prolonging her misery or seeing her suffer and die.

 

OK, I guess I overboarded on the insulin; my immediate reaction was to try to get it lower quickly. I had given her 2 IU this morning but it seemed to not have the desired effect; never seen it so high. She has been diabetic since 11/06 when I began administering her the insulin (always lantus).

Thanks-

 

Hi, wow, what a ride she's having. We can help you help her. Right now her body is trying to protect itself from another hypoglycemic event. And you can't treat the high blood glucose levels with more insulin. Lantus (glargine) is an excellent insulin, it simply needs some basic management techniques to be effective.

I would like for you to get in contact with an emergency vet service and put them on alert. Please tell them how much insulin you gave and that it was given at 10 hours after previous dose - give them the exact times:

"I gave 2U at 8AM and 4U at 6PM." They need to understand you gave the 4U sooner than you should have. Tell them about the low of 16 and how much insulin you gave on the dose before that.

Others have probably posted in the time I've typed this to give you links to hypoglycemic care instructions we have on this board. Please print them out if you can and make sure you have those supplies. A hypoglycemic event on a longer acting insulin can take a while to resolve and you may need to take her to emergency care. I understand it is expensive. If you have those supplies, we can help you treat her if she becomes systematic but she will need more intensive treatment if she becomes comatose. I don't mean to scare you, but a low of 16 earlier on no more insulin than she was given then (was it 2U?) is scary low.

Here is more info, but let's get her through tonight safely.

After 2 hypoglycemic events (the one at the vet's and the one yesterday) your kitty's system is even more sensitive to the insulin's effects. Please do not give more insulin until at least 12 hours from the the shot you gave at 6PM. Also, do not give insulin any sooner than every 12 hours. This insulin has a cumulative effect and works best given every 12 hours.

You are hometesting - you're half way there already! We have a tremendous amount of resources here. I hope you have the time to read a few articles. about how to use Lantus. The best one is called the Tilly Protocol: http://www.tillydiabetes.net/en_6_protocol2.htm

Another with recommendations on how to use Lantus in cats from a University of Queensland, Australia vet: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

Please note both these articles recommend starting dose based on IDEAL weight of the cat, not present weight. This is a very important distinction because some cats are overweight. Please ask your vet about the ideal weight for your cat before determining a dose. To be on the safe side, we usually recommend no more than 1U regardless of weight because we have seen some cats do very well on less than 1U of insulin.

It may not seem like much, but 1U of an excellent insulin like Lantus can do a very good job of controlling blood glucose for cats. Lantus is meant to produce a more level blood glucose over a 12 hour period than other insulins such as PZI or Vetsulin. That's why what you've been seeing is so concerning because Lantus should not produce such tremendous blood glucose extremes - unless it's being overdosed.

We're here for you, please keep us updated on her behavior and blood glucose levels.

 

Here are the hypo instructions

viewtopic.php?f=3&t=1101

This is in case she goes very low again (under 40mg/dl).

 

A thought... has your cat ever tested positive for ketones? Are you currently testing for ketones in the urine? There is infoon ketones here --- > http://petdiabetes.wikia.com/wiki/Ketones The presence of ketone is a concern because if left untreated can quickly lead to a serious condition called diabetic ketoacidosis. You buy buy a product called KetoStix at any pharmacy. You stick a test strip into your cat's urine and compare the color change to the chart that is on the bottle.



Even if your cat doesn't test positive for ketones, it's good to have the test strips handy.

Here are some info stickies about how to use Lantus in cats:
viewtopic.php?f=9&t=151
viewtopic.php?f=9&t=150
viewtopic.php?f=9&t=147

Do you do spot checks on your cat's blood glucose levels or do you only test before giving the insulin? Do you keep a record of those blood glucose levels? If you do, can you share them with us?

There are many people here who can give advice on how to manage your cat's diabetes :smile:

 

Perfectly understandable, I am sure you were a bit jarred when you saw her behavior and saw that number.

Now I have another question. Her behavior is not a normal one for a high number cat, but we have learned here that there is always a cat out there trying to prove us wrong - how long has she been acting like this and can you give us a more detailed behavior report?

Whiskas packets and Karo - good. Is her normal diet wet food? If so, how long has she been on wet food? Does she eat any dry food? If not, how long has it been since she has had it?

 

bump

 

OK, just took the cat's BG a few minutes ago and it's still showing "HI" - has not come down to readable levels. Obviously still sluggish and disoriented..

Vicky - I called my vet and they are trying to get in touch with him; hope to hear back from him soon. I will refreain from giving any more insulin until at least tomorrow per your advice. Will also prepare for hypo conditions if this develops but it doesn't seem as if the insulin has taken hold yet. :-(

Squeem - I believe ketones have been positive in the past, yes. I do have some ketone testing strips but have not used them. Can I use them on urine in the litter box? I do not think she will be urinating any time soon based on her current lethargic condition. I do spot checks on the cat's BG levels and when she is normal (eating and acting normally) have been giving 3 IUs twice per day. If her behavior is abnormal I test BG before proceeding. This saved her the other day when her BG was 16 - I thought she was HYPER and almost dosed her, then waited to go out and buy more BG strips to confirm first.

Carolyn - she's basically been like this for 2 days. She came home from the vet last Thursday and from Thursday to Saturday wasn't in the greatest shape but was at least eating something and drinking a bit. No appetite now and very little water taken. Normally she is pretty active and was actually eating quite well for a few months. I do give her a packet of Whiskas in the AM and PM before her shot. She also has MD dry food in a bowl and was going through about a cup every couple of days, until this.

 

Fresh urine is best. Old urine that's already clumped up in the litter box won't work.

Great that you are testing your cat's bgs at home :smile: If you can, put all your cat's bg numbers into this board-popular spreadsheet --> viewtopic.php?f=6&t=16 Many members find it helpful to track their cat's bgs on a spreadsheet and see how the bgs are responding to the insulin.

 

1/3/10 10:30 am 16 no shot
1/3/10 12:10 pm 317 no shot
1/3/10 2:27 pm 393 gave 1 IU
1/3/10 8:27 pm 265 no shot
1/4/10 8:00 am 585, gave 2 IU
1/4/10 6:00 pm over 600, gave 4 IU
1/4/10 7:28 pm over 600

Was India just recently diagnosed? If you are remembering that she may have had ketones at some point, how long ago are we talking about? In the last few days or last few weeks? Or longer ago than that? Is she eating? Drinking? Is she dehydrated? (you can check by pulling up a tent of her skin - if it pops back into place she is probably hydrated, but if it stays tented then she is dehydrated). Are her gums moist, or tacky? What color are her gums?

Ketone test strips work on fresh urine. Sometimes it is possible to get a test out of the litter box if the sample is very fresh, like if the cat just got out of the box and the urine hasn't soaked in to the litter yet. Otherwise, most people either stick the urine strip directly into the urine stream, or use something (a ladle, a cup, etc.) to catch some urine and then test that sample. Please keep an eye on her and get a ketone test if at all possible.

I'm glad you called your vet because it sounds like India probably needs medical attention, sooner rather than later. Please keep us updated when you talk to your vet.

 

That is totally normal. What happened is that the liver released a bunch of hormones into the bloodstream to prevent a hypo from happening again. That's an extremely simplified version of course, but we call this a bounce or a rebound. It's going to be a little while before she settles down, please don't be too worried about the HIs for now. Of course they are terrible to see, but it's to be expected after two hypo events.

I am glad you have called your vet. I can not emphasize enough that you're gonna have to watch carefully, even later in the cycle, and obviously as late as +12 and later. Those numbers you are seeing are what I would call "falsely elevated" by the liver's response which means they can plummet quickly and you will not see the normal gentle curve you would see in lantus. You MUST test often for at least 12 hours. I know you'll probably want to sleep, but please do not go to bed without leaving plenty of hi carb foods out for her.

I know you are tight on money, but we can help you save money and fix her up. It will require a little bit of work on your part. For instance, she's been 3u BID.. and then you found her at 16.. she definitely needs to start over with her insulin dosing because there's really no way to guess where her dose is without knowing how she got to that 16. That will include you getting more blood tests, both preshot and some spot checks throughout the cycle, do you think you can swing that?

Was she seizing or showing any behavioral responses to that 16?

Are you seeing any neurological behaviors, such as drunk walking or permanent head tilt? If so, how often, and what are you seeing?

Do her eyes look weird? If so, how so?

It's totally possible that her pancreas may have some function left to it, and that the 16 is a result of that. The best way to know is to start logging blood tests and restart at a low dose. With Lantus, we hold doses for a minimum of 8 full cycles before increasing or decreasing. In this particular case I'd expect your dose will have to be restarted much lower and held for a full week. Since Lantus is an insulin that builds up in the system, it can take days for a dose to show it's full effect, which is why we don't recommend changing dose every shot.

 

She was diagnosed in 11/06, the ketones were back then. She is not currently eating and drinking very little; I'm concerned she is dehydrated as pulling up a tent of her skin leaves it tented when I let go. Gums are dry, not moist and dark pink.

Have not heard back from the vet yet. I'm very concerned at this point as the cat is basically lying still with her eyes open, occasionally yowling. If she would sleep or eat/drink something I'd feel better, but at present it looks bad.

I should probably fill you folks in on a personal history: India was hypoglycemic in September, 2008 and a lengthy vet visit resulted in a couple of thousand dollars stay. I fought tooth and nail with my wife to make this happen, when my wife felt it best to put her down. In order to pull it off I guaranteed my wife that was it; no more expensive vet visits. I became a lot more efficient about BG monitoring and I got another 15 months of life for her; India is now almost 16 and we couldn't afford a vet stay even if we were both on board with it as we are having a severe financial crisis now. Neither the money nor the credit is there, frankly and I feel like I'm out of options.

 

I am very sorry to hear about your financial crisis, there are a good many of us in your position right now, and we can all sympathize and understand what you are going through.

Unfortunately India needs to see a vet right now. It appears to me that she is in a crisis situation with severe dehydration and she is in pain. It is possible it is something simple such as pancreatitis but I am now concerned that she has a health issue that caused the hypo's and not the other way around. At the very least she needs fluids and pain meds. Do you feel you will be able to get her in?

While you are waiting for the vet to return your call, please syringe some water into her mouth gently.

 

Thanks Carolyn - I will continue monitoring (also tested the glucometer to be sure it is working normally, and it is) and have left out plenty of food for her. I think I've used up most of the space on both her ears for pinpricks; any other spots which are OK to use?

The cat was not seizing in response to 16, but was acting the same as now: sluggish, drunk walking, and meowing. That's why this is so weird; hyper and hypo conditions seem exactly the same. The head tilt is a new thing I first saw when I arrived home tonight. Eyes seem normal though.

 

Ok well we will be here and we will help you until you hear from your vet, and we'll be here afterwards too. If there's anything we can do to help, we will. I know how you feel, if something were to happen to one of mine, I would have to pray my vet would allow me to make payments.

 

Was she treated for any type of infection?

I'm very concerned about her behavior since she's been treated already for ketones. Try to get a ketone test if you can. The strips aren't very expensive, check at Wal-Mart where they're probably cheapest. Perhaps you can smell her breath - when ketones are high, it will make their breath smell like acetone ~ unscented nail polish remover. But even small amounts of ketones need treatment, so it's best to get the strips.

I see Carolyn suggested syringing some water to her - yes, please do that.

You're doing a great job! Thank you for answering everyone's questions and being diligent in responses. I'm sorry this is happening to India. It's obvious you love her very much.

 

I agree, and I meant to say it, you've been super patient with us and we appreciate it

 

By the way..

Can you list your approximate location? We may have a member near by who could come over and help.. just city/state/province would be good enough

 

Thanks all, will take her to the animal hospital. I appreciate all the comments and support very much, in this very difficult time! Best to you all, more later--

 

Prayers for India

We'll be praying for her recovery. And thinking of you. Many of us have been there.

Please let us know as soon as you can.

 

we'll be keeping you in our thoughts. Please update when you can. ((((Hugs))))

 

Keep looking over to see if you're back, sending lots of prayers and healing thoughts..

 

Here is the link for financial aid ----> http://felinediabetes.com/vetbills.htm It won't hurt to apply for as many as you can. Ask your vet if he/she offers financial aid of some sort, such as payment plans.

Keep us updated on your cat

 

To all:

India was taken to the vet where I am saddened to report she passed away. She was extremely dehydrated and her BG levels were too high. All of your advice and input and support has been extremely valuable to me in the past. I am now wracked with guilt over what I could have done differently. I suppose if I had taken her to the vet at 6 pm yesterday when I got home from work and noticed she was so sluggish that something could have been done. Perhaps I'll never know and maybe it's best that way.

The vet informed me she went quietly and without struggle. It is my hope that her last hours were as painless as possible. I am grateful that at least her miseries are at an end, though mine are only beginning.

Thank you all again and I hope to try to pay back the good karma you've all sent my way with some positive acts in the world to make up for the balance.

 

I'm very sorry to hear this, very sad.

 

Oh no, fly free sweet India

I think it is a very normal thing for us to become overwhelmed with guilt during our time of grief. You can not entertain those thoughts, as there is likely nothing you could have done in those hours. Cats have a way of concealing their illnesses which leaves us no option when their time has come. Perhaps she didn't want you to worry, or she didn't want you to make a fuss, but she decided what was going to happen herself. When you described her skin and her gums last night, it was evident that she had something more serious going on than high bgs, as that is a sign of serious illness.

Please do not spend your hours thinking you should have been able to do something for her, because I believe you could not have intervened in this case. India is at peace now, and some like to think our kitties are at the Rainbow Bridge with The Others who have gone before. Wherever you believe her spirit to be, she is happy, she is at peace, and she always loved you as much as you loved her. Be at peace with yourself. You treated her like a lady deserved to be treated.

(((hugs)))
..Carolyn

 

I am so very sorry. I think you did your very best. I hope that your wife understands your grief. We certainly do ((((hugs))))

 

Deepest Sorrow for you on the loss of your baby! I always think I'm doing something, when something goes wrong with my cats ,But in reality, I have done everything in my power to help them...You are a good bean & tried your best..I'm sure India loved you & you did the best for her..You will be together again..Love never dies!

 

We have made a special spot for your India on our GA (gone ahead) angels board in Grief. I hope you post there when you feel like talking about her or your grief. It can really help.

 

Fly free India

I'm so sorry for your loss. :YMHUG:

Fly free sweet India.

 

(((((HUGS)))))
i am so sorry for your loss.

 

I'm so sorry.

 

I'm so sorry for your loss

 

I am so sorry for your loss.

 

I'm so sad to read this. (((hugs)))
Fly free sweet India.

 

I'm very very sorry to read this news today. You and India were in my thoughts all night.

Please try not to feel guilty. You recognized that there was a problem, asked for help, and acted quickly to get her to the vet. It was obvious from your posts last night that you love India very much. She knows that too.

 

Farwell sweet India

Fly forever free precious India.
This is hard to write as I too have a broken heart from losing my Noisy not too long ago.
I'm sure they still love us -- it is from a different place now. I requested Noisy to run and greet her. I am so sorry for your loss.
I bet India absolutely loved you -- I can tell from your post that you are a special person.

 

That's so hard.
I understand that you beat yourself up. Sometimes doing your best isn't working out.
I wish you the best, keep a place in your heart for her.
I'm sure she did.

 

I'm so sorry to see that your sweet India lost her battle and had to leave you. Sometimes in spite of all our efforts, there is nothing that can change the fact that they must leave but that doesn't help the hole they leave in our hearts and lives.

She is free of any pain now - and will never feel pain again. I'm hoping the wonderful memories you have of your time and love together console you in your grief. They leave so much with us when they leave us.

Emmy & Dude (& Mittsi too)

 

I am deeply sorry for your loss.

 

I'm so sorry for your loss. You've been a great advocate for India, and I hope you always remember that.

 

I am just stopping by to send you condolences on the loss of your kitty. India had your love and care; but they leave us at some point, and not everything in this world is under our control. She is free of pain, and I hope you will very soon find comfort remembering all the good years you had with her. I truly believe she knows you loved her.

 

Thank you all so much. I've been trying to get through the day in a daze of grief and guilt and your comments have all made things better for me. I'm a 38 year old guy who's been brought to tears several times today over this and faced with such a sense of loss that I could barely focus on work (though I felt it better to be at work than go home and suffer the emptiness of my basement, which is where my cat primarily lived). I can handle the fact of India's death better than the horrible sense that I could have done something differently to help her or ease her suffering, and the condolences from you folks are what helped me get through the day.

Carolyn, you said: "Please do not spend your hours thinking you should have been able to do something for her, because I believe you could not have intervened in this case." I spoke with the vet this evening and he also fairly well confirmed this. Even if I had taken her to the vet immediately yesterday evening he thought there was maybe a 10% chance she would have survived. Her kidneys had failed; she was out of options so I do not believe I killed her through negligence. All I could really have done was had her euthanized last night and I gave her what I felt was a fighting chance when I thought perhaps all she needed was insulin. Dosing her with 4 IUs was the wrong move, but it did not kill her nor would not have doing this saved her. When I took her into the vet her blood glucose was over 750. It never went down.

Three people have pointed out to me the fact that when cats are ready to die their symptoms spring up rapidly and without much hope of a cure. Truthfully, as an obsessively analytical person who feels guilty when making a tough choice regardless of which decision was made, the only way I would not feel responsible for India's death would be if she died peacefully in her sleep. I'm grateful I was not forced into the awful scenario of being told "We might be able to save her but it will be very expensive and the results are not certain, or you can do the easy thing and put her down now."

A part of me considered last night that India was dying and that if it was the case then it was best it happen at home. Looking back it's hard not to point a finger at that as being negligent. If given the choice between lying in an unfamiliar vet bed for hours and then dying or being here at home in her basement and being taken to the vet at the end I am sure India would have preferred to be at home as long as possible. I am sorry I was not with her when she passed away but the vet informed me she was basically in a coma then and would not have been aware of my absence. I had envisioned myself being with her at the end to help ease her transition.

The vet is holding India's remains in cold storage until I can decide what to do with her. At first I wanted to bring her home and bury her in my yard, but the ground is frozen and this would presently be impossible. They are willing to wait until spring, or I can have her cremated and keep her in a sealed urn. I had not previously valued the concept of cremation as I don't believe the soul remains with the body when animals and people pass on, but my sister pointed out to me that I could have India's ashes buried with me when my own time comes, and I think that is what I will do. Whatever else life may bring, I feel I tried my best with her and am 99.9% proud of doing all I could for her. India was with me from kittenhood (I got her when I was 23 so that is most of my adult life) until a few minutes before her death and for the rest of my days she will be My Cat.

Today I found out several things which I plan to always remember: the world is a better place thanks to kind and caring people like you, I have some very nice coworkers and family members who expressed their sorrow and condolences and they are now more special to me than ever, and I owe some support and good will back to this world to help repay that which has helped me today.

Thank you all again!

 

Wow, I could barely finish reading this thru my tears. You are a special person and God gave you a special friend/angel to hang with you these past 16 years. I think we are given these precious friends for a lot of reasons, to keep us happy, to keep us company, and sometimes to challenge us to be a responsible and better person. You are not out of balance in the karma department, you loved and cared for your kitty with every drop of your being, never doubt that for a second. India was 16 and it was her time to run back to her creator... she's happy and purring in someone else's lap now. don't be sad, be proud and happy for her.

 

I am so very sorry for your loss.

~M