Would love your thoughts re: our cat's recent hypoglycemia

Hi! This is my first time posting here but I could sure use some thoughts/advice from cat people a little more experienced in dealing with feline diabetes than I apparently am! I'll try my best to keep this really short and to the point but it seems like a lot has happened over the past week.

Our cat Tyler is 14 years old and was diagnosed with diabetes over a year ago. He gets one unit of Humulin N twice a day. We do not monitor BG at home but have had no problems/issues until recently.

Last Wednesday evening Tyler exhibited many classic symptoms of hypoglycemia (restlessness, head tilting, shivering, turning in circles, problems with eyesight, vomiting, disorientation and finally seizures) so we gave him karo syrup and rushed him to the nearest emergency vet. He wasn't seizing anymore when he got there about midnight. BG was 68 and potassium was low. It looks like a few of the other blood tests results were abnormal but I'm not sure what the abbreviations stand for. In addition to the hypoglycemia, we found out he has hyperthyroidism. Stayed overnight for IV and observation. BG was 184 at 5:15 am.

We took him straight to his regular vet from the emergency clinic. His BG there was 169. We were advised to skip his morning insulin but continue with his normal dose in the pm. Also given pills to take 2x day for the hyperthyroidism.

We were *very* nervous about giving him a full dose of insulin Thursday night so we only gave him about 25%. About 2-3 hours later he was acting funny and twitching/jerking quite a bit. We again gave him some karo and coaxed him to eat and he came out of it. Friday and Saturday he seemed OK - we continued to give him a fraction of his regular dose of insulin. Sunday night he had seizures again. Karo syrup and food stopped them.

Called his vet on Monday and were advised to feed him as usual Monday & Tuesday but discountinue all insulin, and bring him in this morning. So after two days with no insulin his BG level this morning was 90. Vet wants us to give no insulin the rest of the week and bring Tyler in for another BG check on Saturday morning.

We are so confused about this whole situation and have so many questions we're just not sure where to begin. We've read about the "honeymoon" that some cats experience but were under the impression that such a period usually happens shortly after diagnosis - not over a year later. We have talked about the possibility of problems stemming from a pancreatic tumor but are unclear what this actually means in terms of diagnosis/treatment/prognosis, etc. I really think we need to monitor BG at home but our vet does not seem very supportive.

Anyone have any thoughts or experience that may help? We sure would appreciate it!

Jennifer

 

I don't have direct experience to offer, but I think you are absolutely right that you need to start home monitoring. Your vet does not need to support or recommend it; you don't need a prescription for testing equipment. People here can help you learn how to do it.

Your kitty has shown you very clearly that injecting insulin without testing is not a safe procedure. You have come to a correct conclusion. Now, your kitty will thank you if you follow through on it!

 

I did not home test in the beginning either. Peep's hypoed 9 months into her treatment for diabetes. She has not had to have insulin since that time.

Home testing is beneficial for your sanity and your cat's welfare. I regret my decision to leave the testing up to my vet. It almost killed Peeps.

Where you are in your treatment is a very scary and unknown place. You probably feel just as shocked and confused as you did during the diagnosis of feline diabetes. What you're feeling is normal, and seeking advice in this situation probably makes you feel extremely vulnerable! There are people here who have been down that road, and want to help you through every bit of it.

Is your vets disapproval of home testing the only thing that is holding you back? If so, you have several options for beginning to home test. One of our members offers a service for free starting kits to get you on your way to home testing. You can view her post regarding the testing supplies here: Request a starter home testing kit. It will take some time to get one of these testing kits, so if you want to start immediately, going out and buying your own supplies is quicker. You can pick up testing supplies at any pharmacy. Human meters will work for your Tyler, and are less costly than the meters marketed towards animals. The ReliOn testing supplies found at Wal-mart are the cheapest. I have no experience with that brand of meter, so I will allow someone else to go that route with you.

Home testing can be extremely stressful in the beginning. When shopping for a meter, check to make sure it needs a very small amount of blood. This will help you through the beginner home testing blues. Posting your location will help other members get in contact with you. Some people will make house calls to help you learn how to home test if you need assistance. When I began home testing, I poked and prodded myself and my human family members for practice. It helped me learn that I did not do well with the lancing device that came with my meter. I "freestyle" using only the lancet.

Make sure you document Tyler's numbers. There is nothing worse than thinking you wrote it all down only to find out you didn't! All that blood for nothing! I keep a paper copy, and a copy on my computer, just in case. It also helps to keep notes with the BG readings, so you know when Tyler ate, was acting strange, or what time it was when you tested. It will help you in the future to know how his BG reacts to foods, his mood, your mood, or the time of day.

Good luck to you and Tyler! Throw out any questions that arise, there is always someone around who can help.

 

Whether your vet is supportive or not, home monitoring saves lives. We owe it to our diabetic furbabies to home monitor them. As you have found out the hard way, a sugar kitty can become hypoglycemic in a very short time regardless of if they have been on regular insulin dosing for a day, a month, a year, or a lifetime.
Regardless of what your vet says, everyone should home monitor if they have a pet who is a diabetic.

Insulin needs can change quite dramatically at anytime, and if unmonitored dosing is happening, you are placing your furbaby at high risk of something terrible happening. Home monitoring, after practice, becomes very easy for most kitties and their humans. I cannot stress the importance of at minimum, doing a pre-shot bgl test before each and every insulin injection. The home testing cost is minimal in the big scheme of things and to not home monitor means your cat's very survival might be at stake. Also, it is far, far less expensive to home monitor than having it done in your vet's office, or having to rush your baby to the ER because it went hypo because home monitoring was not done.

~M

 

Jennifer,

I applaud you for wanting to hometest. If I can still do it, the link to information on hometesting is:
viewtopic.php?f=14&t=287#p1665

A lot of times when a cat has a hypo event, they become more sensitive to the insulin and may honeymoon, or even go into remission. That is what happened with Pooka and I hope it happens with you.

 

You obviously have good instincts where your cat is concerned. It is hard to understand how a vet can be opposed to home testing when there has been a hypo. (although many are). How can you have too much information in a situation which could lead to death? Testing is sometimes a little frustrating at first, but once you get the knack (and everybody does!) it is quite routine and easy. And you'd be surprised, but it often strengthens the bond between you and your cat (they know you are taking care of them? they like the extra attention? they look forward to the treats they get rewarded with?). There are tons of people here to help you if you run into any difficulty. Keep us posted.

 

Where are you located? City and state? Maybe someone is near you that could help you and show you.

I would definitely home test to save my cats life. Sounds to me, in my opinion, that your cat does not need insulin anymore. Sounds like the pancreas is stuttering and may take off on its own.

The only way to confirm this, however is to do random tests throughout the day, before eating and definitely no insulin.

 

Yes, absolutely learn to hometest. This is my favorite site for hometesting info: http://www.sugarcats.net/sites/harry/bgtest.htm We all have tips and ideas that have made it easier for us. Come back on and ask.

For starters, my first tip is to buy the meter and try it out on yourself first. That way you are confident when you go to use it on your kitty.

 

I don't know about a year after diagnosis, but honeymoons can certainly happen later then just a few months after diagnosis. Yittle was diagnosed at the end of May 2009, he had lost a lot of weight so we now realize he'd probably been diabetic for at least a few weeks if not a month or two before diagnosis. He had his last insulin shot at the end of November and has been in diet-controlled remission (honeymoon) officially since December 14th. So thats 6 months later, about 3-4 months of it on Vetsulin, the last portion on Lantus. I know of several other cats that honeymooned awhile after diagnosis if they were switched to Lantus from Vetsulin.

Home testing is the only way you'll really know whats going on, please take advantage of getting a free newbie kit from here, or go out to Walmart and buy the Relion Micro meter and strips that so many of us use here with great success. Its one of the cheapest meters on the market as our the strips and its been rated very highly by many people and organizations.

I won't say home testing is easy, because it may not be so for you. But it could save your cat's life. When Yittle was coming off the Lantus and we were having to step his doses down he went borderline hypo so many times I lost count. Luckily because we were home testing we were always able to catch it and treat it with higher carb food (not karo syrup) and just monitor him to make sure his blood sugar didn't go any lower. Had we not been home testing him there would have been several vet visits at a minimum, or worse. I know on several occaisions had I given him his usual dose of Vetsulin without home testing I would have killed him because his blood sugar for whatever reason that day was lower then the number of points he typically dropped on that dose. Giving him insulin those days and then going to bed or going out would have been life-threatening.

As it is, Yittle is happy, off insulin, and looks better then he has in years. He also frequently asks for a blood test - he still thinks that testing or shots equals nice yummy food after so if we're late in feeding him he'll go to the desk where we used to give him his tests and shots and hop up on it and plead with us to do it. He even used to wake me up and tell me it was shot time and go running to the desk ahead of me to wait for his tests and shots. So banish the notion that testing has to be traumatic for your cat, it doesn't have to be.

 

Thank you so much for your advice and encouragement. I really appreciate it.

First, an update on Tyler's status. He saw his vet Saturday morning - his BG was 89. This is after 5 days of no insulin. There have been no further hypoglycemic episodes. In addition, his weight has gone from 8.9 lbs to 9.07 lbs. in the last 12 days. The vet says this may be "spontaneous remission." Is that just another way of saying he's on "honeymoon"? We are to take him for another weigh-in and BG check in two more weeks.

As far as home testing goes... Tyler does very well with his insulin shots, barely noticing them most of the time. I'm pretty sure he would adapt well to BG monitoring at home. *I* am the one who will have difficulty. I'm a huge baby when it comes to needles and don't think there is any way I could try a lancet/meter out on myself first. If it comes down to it I will absolutely learn but even the thought makes me nervous/queasy. Luckily, my husband has no such issues! But I know I'll need to be able to do it too...

Question - if we start hometesting without the support/approval of our vet do you think we should try and find a vet that *is* supportive? And if we don't/can't how will we know how much insulin to give based on the BG results? (ETA: If he should he need insulin again sometime in the future.)

Thanks again for being so helpful. I lurked quite a bit here when Tyler was first diagnosed and this messageboard and the associated website is truly an invaluable resource!

 

Wonderful news that his BG is good & weight is coming on...your boy has blessed you in the middle of a mess. I love happy endings, Congrats!!!

 

Hi, I don't have too much experience on this, but I can say that I just started hometesting my two diabetics. I read somewhere that the Freestyle Flash was a good meter to get so I bought one on Amazon for $25. It only needs a teeny tiny drop of blood. I was nervous at first so first I tested on myself, then my 11 year old daughter offered her arm (didn't hurt at all) and then took to the cats. I've probably done about 6 tests so far and it's got pretty easy. Check out the various videos (on Youtube as well), they are really useful! The sock with uncooked rice inside (heated up in the microwave) is a very good tip to hold against the ear to warm it up. Have also taken my boys off dry prescription food and now have have them on low-carb, hi-protein food which has reduced their insulin needs. Good luck with it--do check out the video links for hometesting and give it some time!

 

Welcome back! That is great news about Tyler. 89 is a great number, especially while at the vets office. You may be able to celebrate a remission!

OTJ, diet controlled, remission, honeymoon - these are all ways we talk about kitties not needing insulin anymore.

Giving up your vet to find a more home testing friendly doctor is completely up to you. Your vet may not be supportive, because he isn't as wintered in home testing as many of our members are. If he is adamant about not learning with you, I would suggest finding someone else to treat Tyler. BUT it might be worth while to attempt home testing and keep your vet updated with his home bg readings. If he is daft enough to let a paying customer go after you have "proven" you can home test, but all means, take your hard earned cash to someone willing to be supportive!

Personally, I have told myself I wouldn't reintroduce insulin to my Peeps until she regularly read around the 200+ range. She has only read above 100 twice, and I think I was the cause of stress that day that shot her bg numbers up. If you do find yourself needing to reintroduce insulin to Tyler, I would recommend starting at an extremely low dosage. You will not want to reintroduce the amount he was on before. Monitoring how his body handles the insulin, and with help from people here, you'll be able to see when he needs his dosages increased or decreased.

There is a very nice wiki site that shows the bg numbers and what to expect at each range, which can be found here: Blood sugar guidelines. I can't tell you how many times I have used this one page to ease my mind about jumping numbers.

 

Got it. So can remission be permanent or is it more likely that Tyler will again need insulin at some undefined point in the future?

So how often (and when) should you test the BG level of a cat 'in remission?'

ETA: And thank you so much for that link to blood sugar guidelines. Very helpful!

 

You aren't still giving insulin are you?

 

No - the last insulin shot Tyler got was about half his normal dose last Sunday evening, 3 January.

 

Whew! for some reason I read your post to say you were still giving insulin!

 

You're right - my question about knowing how much insulin to give based on hometesting results was confusing! I tried to clarify my post above! :smile:

 

It is hard to say if Tyler will need insulin ever again. I count myself fortunate that Peeps has been OTJ for so long, but I always keep it in the back of my mind that she could need the assistance of insulin again at any time. There are many cats here who have had to go back onto insulin, and many that have been off for years.

Test as much as you feel comfortable with. In the beginning I did a few day long curves to see what she was doing throughout the day. Then I went to once or twice a week after a few months of great numbers. Now, I usually test once a month at most, unless I feel Peeps' behavior is off. She made me worry a few days ago, but after a few readings I saw that maybe she was just feeling under the weather and my fussing had made her bg rise. I had left the house for two hours, and her bg fell drastically while I wasn't here poking and prodding her, and following her around like a shadow.

You should probably test fairly often in the first few weeks, just to be sure. You will know when you feel comfortable with the numbers you are getting. Tyler will also let you know when things are off and when you should be worried. If you're like me, you will be worried all the time. The great thing about having a home testing kit, you can worry, and then know exactly what is going on within minutes.