? Cat acting strange after starting insulin - but not hypo

Hi all,

My first post! Hopefully I did it correctly.
I gave my cat his first dose of insulin (1 unit twice a day of Lantus) about 22 hours ago - at noon yesterday. He was acting fine all day and eating normally and everything. I gave his second dose of insulin at 1am (about 9 hours ago) and before I gave it, his BG was 394. But after that, he did not eat and is acting weird. I tested his BG at 9am and it was 405. He usually eats all his food overnight but he did not even touch it. He threw up a TINY bit this morning but I am assuming that is from not eating. Now he is not eating food or not even his favorite treats. He is acting kind of lethargic (just sits there quietly while I test his ear which is not normal for him). He has spent the morning sleeping under a chair which is where he goes when he doesn’t feel well. My vet told me to just monitor him today and give insulin as normal but to test him mid-afternoon and let them know. Has anyone else experienced this after starting insulin? He has been on Lantus years ago before remission and nothing like this ever happened. He also got an ear med on Wednesday which they said 1% of cats have a sensitivity to, but I don’t think that is the issue. I am not sure though idk why he is acting like this???

 

Hello and welcome!

I think the thing I'd be most worried about, from the symptoms you describe, is ketones. I'd try to get him tested for ketones asap to make sure that's not what is brewing. This can be done by taking him to the vet (where they can also check for other causes), or by testing his urine at home (requires a trip to the store to get the test strips, and for him to go to the catbox soon).

Ketones/diabetic ketoacidosis (DKA) are very dangerous diabetes complications. Whatever ear issues led to the ear meds might have been a trigger.

More info here: Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

 

Another possibility would be the somewhat coincidental appearance of a new health issue such as pancreatitis. If you take him to the vet (which I frankly would if I were you) and he tests negative for ketones, you can have them test for pancreatitis by either the SNAP fPL (immediate yes/no answer) or Spec fPL (has to be sent out for analysis, gives a more detailed picture of the severity).

Pancreatitis is managed symptomatically-- pain meds are a must, plus anti-nausea meds. More info here: A Primer On Pancreatitis

 

Thank you. He has had a pancreatitis flare-up once before back in March of last year and I was kind of wondering if it was back again. (Or still here — idk how it works). I think I will call my vet back now and try to rule out pancreatitis if possible because it was so scary last time. Thanks again for your answer!

 

I wouod test his urine for ketones using a test strip upi apply urine to. You can usually get them at a pharmacy. The behavior you a describing could be diabetic ketoacidosis (DKA) which is serious. I would also quickly call you vet too.
https://www.petmd.com/cat/conditions/endocrine/c_ct_diabetes_with_ketoacidosis

 

Sounds like a plan.

As Larry emphasizes, the truly dangerous possibility is ketones/DKA, and time is of the essence there. If you can't get him to the vet today then it is critical that you test his urine yourself at home.

Anything above "trace" means an immediate trip to the vet or ER vet. Things can deteriorate incredibly quickly in a DKA situation.

 

Thank you all for your input. His regular vet is not in today but he has an appointment with another vet at 3:45 today - so in about 4 hours.
Would you all suggest still giving him his insulin at his normal time (about an hour from now)? Or just wait and see what happens at the vet?
I am thinking about going to the pharmacy now to get ketone test - I remember seeing it there yesterday and I almost bought it just in case.

 

Since you have not provided any history of BGs like a spreadsheet, I can't say whether to give some insulin before the vet visit.
What ear med? many contain a steroid that can raise BG

 

Sorry I am still getting the hang of this and he JUST started insulin yesterday - I just successfully tested his BG at home last night for the first time.
I forgot to ask the name of the ear med, I meant to ask. But she did mention it was a steroid and he also is currently on 0.4mL 2x/day of Prednisolone which I also know can affect it. She said she thought this ear med was his best option though since I tried Tresaderm drops and it didn’t clear his yeast infection.

 

What's his BG?

 

Last night it was 394 and two hours ago it was at 405. I also just called his vet because I dropped off a urine sample on Dec 23. I just asked if that sample had any ketones in it, and they said it did not. Are the ketones something that could have developed since then?

 

Yep. They can build up in a matter of hours.


Mogs
.

 

Yes, ketones can develop very very rapidly. Dec. 23 is ancient history from that perspective.

If his pre-shot BG is over 200, I'd shoot. The only downside is if it is ketones and he needs treatment, they'll have to adjust how they administer any short-acting insulin. But they ought to be able to handle that.

How is he acting now?

 

oh wow okay I had no idea, thank you. I just put in some non-absorbing litter and I’m hoping he will urinate before his vet appointment later. I’m about to go get some ketone test strips now.
he still has not moved out from under the chair - I check on him constantly but he is always just sitting there wondering why I keep petting him LOL.
I will give his insulin as normal though, and that is also what my vet told me to do when I called earlier. Thank you so much for all your help, clearly I have no idea what I am doing yet.

ALSO I FORGOT TO MENTION THIS
In his previous urine test she said there was some blood and high white blood cell count. So she thought he had a UTI. He just got an antibiotic convenia injection on Wednesday. But now that I think about it - this is the same thing that happened last time he had pancreatitis. The ER vet thought he had a UTI and then he started having diarrhea and his pancreatitis went untreated for a few days until we found out that is what was happening. So that might be it but we will see I guess!

 

Awww, poor little guy! Whatever it is, I'm glad you're taking him in today to get seen. Hopefully he'll be feeling much better soon!

 

None of us do at the beginning! That's why God gave us FDMB.

Don't worry, it'll all become very familiar, and much sooner than you might currently think.


Mogs
.

 

update for anyone wondering - he has pancreatitis. No ketones though and his bloodwork was normal other than abnormal pancreas levels. Started him on subq fluids, pain meds, and cerenia. Thanks again everyone for all your help!

 

Aww poor guy, I hope he feels better soon