help needed: cat threw up after shot, what should I do?

So tonight Comet hit the parameters his vet gave me for insulin: 1/4 unit of Lantus if he was >250 and had eaten a good meal. He was at 279, he ate a good meal, I gave him a shot, and he threw up a few minutes later. What should I do? He's never thrown up after a shot before. He seems okay and is sitting next to me as I type this, but I am quietly freaking out.

 

@jt and trouble (GA) hi is this one you can help with or flag to anyone else who can help poor Jenny who is freaking out.
Probably someone in the USA or Oz as most folks here in the UK will be tucked up in bed!!

 

Or @Diane Tyler's Mom are you able to help as I see @jt and trouble (GA) is rescuing her burning dinner at the moment !

 

@Bron and Sheba (GA)

Sorry I'm juggling a lot right now. my bast advice is try to get kitty to eat small portions. Keep feeding by the spoon full.

 

Sorry for picking on you @jt and trouble (GA) - could see you were around and is a penalty of being on my always so helpful from USA list. Hope you saved your dinner

 

With Lantus you have about a 2 hour window till it kicks in. Can you keep trying to feed him as JT suggested? I’d try treats and baby food as well

 

Btw, this has happened with Minnie several times. And I got so used to it even when she vomited before the shot, I’d still shoot her because I knew I had 2 hours to give her anti nausea med and get her eating again.

Let us know how it’s going. If he just regurgitated, he should eat again soon without problems

 

He took a couple of bites a few minutes ago and threw up again. What happens if the Lantus hits his system and he doesn't have any food down? I have baby food.

Will stress from throwing up make his glucose spike?

 

Don’t worry about the stress of throwing up. That shouldn’t be a factor. Do you have any antinausea like Cerenia or ondansetron?

 

Does he have a history of vomiting?

 

No, he hasn't needed it before. What happens if he doesn't have any food down by the 2-hour mark? I think he will be willing to eat, he doesn't look bad, I just worry about trying again too soon. But of course don't want to try too late if that will have bad results.

 

And I don’t see a spreadsheet link in your signature. Do you have one? It would be helpful to see his bg range with the current dose

 

No, just the occasional normal vomiting. From eating too fast (what I think happened tonight) or hairball.

 

It’s hard to say without data on testing. How long since the shot? I’d wait a little to give him a chance to get over it

 

I was going to say try some baby food, a little at a time

 

Lantus starts slowly and it’s different for every cat how soon it does start to work, but usually never before 2 hours. Again seeing a spreadsheet with testing data would help answer your question. If you test often and you have +2 data, that should tell you how he reacts to the insulin around the 2 hour mark

 

lol I did now just need to eat it

 

Ale I see in her signature the free style libre sensor

 

A bit over an hour since the first time, maybe twenty minutes since the second.

I am sorry I don't have my spreadsheet up yet, we had a period where he wasn't getting any insulin at all and I was using the charts in an app (FreeStyle Libre) there. I can share what I have but it won't be very useful and I can't get it to share because the name is too long and I can't find the sticky that tells you (hopefully) how to give it a shorter name.

 

Does he have on the freestyle libre sensor, I see it in your signature

 

Yes, he does. He was at 279 pre-shot, +1 305.

 

Okay great! If you have the libre you can monitor and that buys you more time.

If he stays above 50 he’s safe. 50 is the take action number on a human meter which the libre is

 

Will empty stomach + Lantus make him go down that far??

He just had a few licks/bites of chicken baby food.

 

Probably not I’m just giving you worse case scenario for reference. I’m not sure how the libre works but can you look back at previous days to see how low he goes after +2 and what his nadir had been? That should give you some idea

 

He actually is only just starting insulin again after an unexpected break of a couple of weeks -- I want to add the values he had during that time but have not had time. I have just posted the spreadsheet, but you will see it doesn't have much info to work with. But from what little there is, it seems like insulin sends him down quickly -- his nadirs were before six hours.

 

How is it looking now? Can you try some baby food?

 

Ale she has the SS filled in

 

Sorry for the delay in writing again, he came up and sat on me and purred and demanded scritches for a long time. Just jumped down to have a few more bites of the baby food. Looks like he is at around 280 now at about 2-1/2 hours out. So, close to where he was before the shot. I will continue to watch and worry but am cautiously hoping that these are good signs and will continue.

 

OK that sounds good , glad he had some more baby food. Can you put that 280 in the spreadsheet please , you would put 280 @+2.5
Whenever you can just keep putting his BG on the spreadsheet

 

And you may not be used to the low numbers yet, but anything between a 50-70 is pretty awesome so don’t get nervous if he goes that low. It’s actually a reason to celebrate!

 

Looking at the numbers you have in there now, I wouldn’t be skipping doses. If he’s staying consistently in the 200’s, he needs insulin. The goal is for him to be in blues and greens most of the time.

 

Normal range is 60-120. Anything higher than that still requires insulin fyi

 

What would you suggest? The vet told me 1/4 unit if he was at 250 and had eaten; if he is lower than 250, she doesn't want me to shoot. She also thought he could do just one shot a day. I didn't think that was right based on what I have read here and asked her about the importance of twice a day doses on Lantus due to it being a depot insulin and she said, "Well, it's twice a day for some cats, once for others, it really just depends on the cat." Editing to add that he started out at 1 unit and then 1/2 but seemed sensitive to that much, so decreased to 1/4.

 

I am going to tag a few people that might suggest a no shoot number for you.
No way should you give lantus once a day.

@Bron and Sheba (GA)

@Panic

@tiffmaxee

@Deb & Wink

Ladies would you mind taking a look at Jenny's spreadsheet.
She made some notes on it.
Comet has the freestyle libre sensor on.
Please take a look at what's been happening
Thanks so much

 

Twice a day for sure. I’d give him his regular dose if he’s over 200 that way you’re pushing his numbers down a bit and closer to the desired range. Especially with the libre on since you can always monitor to see how low he goes.

 

Thank you Diane! Let’s see if we all agree

 

And have you read all the yellow sticky notes on the Lantus forum? In particular, the one about the dosing protocols because it gives you suggested shoot and no shoot ranges. Honestly, I get nervous still under 200 but yesterday I gave Minnie her full dose with an amps of 148 and with the help of folks here she stayed safe all day and in the green range which is what we want. And her numbers are better today because of it. You have to push the comfortable boundary a little to get better results.

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Don’t get me wrong, his numbers are not bad but I’d definitely be shooting if he’s over 200. I think 250 is too high a of a no shoot threshold

 

Hi. Welcome. You definitely want to shoot every 12 hours. You are using a human Libre, correct? The normal numbers for a cat on a human meter are roughly 50-120. So the numbers on your spreadsheet for what’s considered normal don’t make sense. Was Comet diagnosed in September?

 

I have read and wonder how you get the guts to do it. We've had to run to the emergency vet twice due to sudden lows -- they thought he was sensitive to the insulin, so we moved to the 1/4 unit. But he's been on it for such a short time, it's hard to tell what would be right. I am so anxious about everything all the time.

 

When you ran to the vet was it because if the bg number or was he acting strange?

 

Yes, in September. The vet doesn't want him to go below 70, at least not yet. We had two scares in September.

 

Explain the scares please.

 

238 at +3, added to spreadsheet. Had a few more bites of baby food, now sitting on me again.

 

I would definitely go back to twice a day shots. Lantus needs to be given twice a day to be effective and to maintain the depot.
I don’t agree with the vet who says some cats only need once a day dosing with Lantus.

You also need to look and see what dosing method you are going to follow. That will make a difference as when to increase and decrease the dose. So if you could look at two that are at the top of the Lantus page and see what you think. Either SLGS or the TR method.

Comet was actually managing fine in 1/2 unit twice a day But for some reason was swapped to 1/4 unit.
So if you would feel more comfortable with the 1/4 unit, you could start with 1/4 unit twice a day and see how you go.

I would start off with a “take notice” number of 200 and if you get lower than that ...stall, don’t feed and ask for help. Retest in 20 mins to see if it goes up. Then gradually reduce the number you will shoot as you get data.

 

Because he threw up feed small amounts every 30-60 minutes to be sure the food stays down.

 

@tiffmaxee Thank you Elise

 

@Bron and Sheba (GA) Thank you Bron

 

What I am wondering is whether he had a symptomatic hypo or you went to the vet because of a low bg reading. I know when I first saw a 60 nadir I was scared but my vet wasn’t. Max often dropped into the 40’s once regulated but never showed any symptoms of a hypo.
Do you have high carb foods and honey or karro syrup in case you get a reading under 50? If that happens someone here can help you get through it and not need to go to the vet.

if I were you would read the SLFS method and start with that. You will find it on the Lantus forum.

 

The first one was very early on after they had done a curve and told me that's all I needed to know. I came home after running an errand and he was hiding someplace he never goes. I took one look at him, scooped him up, and ran. The vet who took him in at the practice that day confirmed he had gone too low. They kept him overnight to be safe.

The second one is on the spreadsheet. He didn't seem off, but the vet had told me to call if he went below 70, she did not want him to go below that until he was more established in treatment. I called the emergency nurse and kept checking and watched the numbers drop into the low 50s. She told me to feed him honey and a high carb food and I did but his numbers weren't going up, so she told me to get him to the emergency hospital. I did, and they tested him at 84. At the time, I wondered if it was the honey/gravy food kicking in finally. But now when I look at it, I just don't know. Maybe he was still fine. But it looked like he was going to keep going down.

The emergency vet advised the 1/4 unit dose. She said that Lantus seemed to drop him quickly/early and that he might be sensitive to it at the higher doses.

 

When he started to drop lower did you feed him or just watch to see what happened?

 

I’d be curious to know how low bg at the first ER visit. I think the second visit was more about yuh enigma cautious and I don’t blame you at all, but if that ever happened again, you’d post and ask for help and someone here would guide you with testing every 30 minutes and feeding to get his numbers safely up. Of course with the libre, to don’t have to do any testing. I assume also he didn’t have the libre a the time of the visits right? That should help you feel a bit safer.

I posted the link to the Lantus dosing protocols above. Check it out but I’m sure you don’t want to do TR, which is more aggressive. SLGS is the one for you.

 

I was writing when you posted. The first time, it was definitely a hypo; the second, I am not sure and wonder about. It was three a.m. and honey and high carb food didn't seem to be helping and I was terrified. When the emergency nurse told me to go, we bolted.

I have honey and syrup and some high carb foods.

That method is the one that seems more doable to me. I am lucky right now in that I am working from home due to the pandemic, but I will probably be heading back into the office in a few weeks. I am trying not to think about the yet, but I don't understand how I am supposed to shoot him and then waltz off to work and not know how he's doing until I get home. It makes me want to throw up. I am really anxious to get into a good groove before then.

 

I think it’s normal given the 2 scares you had. You will start to slowly feel better again and I think the libre was a great choice for you to help you feel safer about his levels.

 

The first one, he didn't have anything, and they didn't tell me the number, or I was too upset to retain it. Actually, no, I know they didn't tell me. A vet came out to talk to me herself (we can't go into the clinic due to coronavirus) and told me and was just incredibly kind about it. (He's seen three different vets at this practice.) But she didn't give me a number. The second time he did have the libre, but it shows alarming signs when it goes anywhere under 70, which is the mark the vet wanted me to use, and seeing 50s was tremendously scary.

Thank you so much for all your help tonight. I really, really appreciate it. You have been so helpful.

 

We will help you figure it out. I know people do TR and work full time but I never could have done that. But we will help you get to a point that you can leave for work. One thing you will need is an auto feeder that you set to open and feed him while you are away. It works well at night so you can sleep without worrying when he’s in more normal numbers. We will coach you so you know what to do. .

 

191 at +4, added to spreadsheet.

 

I can get one. I have another cat who doesn't have diabetes; they eat at the same times. Will it be able to hold meals big enough to feed them both? I have seen the notes about having icepacks for them, does that work well? I have never been able to get either cat able to eat food after it's been refrigerated/cold.

 

Has he eaten any more? I’d feed him a couple teaspoons.

 

It would be best to get two, one for each. There’s one that I believe comes with ice packs. Susanne uses it and likes it. I’ll tag her for you to get the one. @JaxBenji

 

How late can you stay up? It would be good to see where he’s at @+5 and +6

has he eaten some more?

 

He had another few bites and walked away to sit next to me again. He likes it okay but doesn't seem to love it like a lot of cats do.

 

Or you can train yourself to wake up at +6 and feed him like I do haha! A little humor for ya

 

Will definitely stay up for +5 and will try for +6 too. He did have a few more bites.

 

Small amounts is fine. If his appetite isn’t back to normal tomorrow I think you need nausea medication and would call the vet.

 

Are you still free feeding dry btw?

 

I have to say I don't sleep very well these days, which is why I caught him for the second scare. If I had just slept maybe everything would have been fine. But I woke up and since I woke up I went over to him to check, and then it went on from there.

 

No, we stopped. Wet food only, mostly Fancy Feast Classic pates.

 

Got it. Sorry I got confused with the info in the signature. Hopefully tonight will also help you feel safer about giving him insulin

 

147 at +5. That is 132 down from his PMPS of 279, almost 200 down from his post-vomit high (+.5) of 330. How worried should I be? Should I try to get him to eat more?

 

Yes try to get him to eat again now. Still not a bad unsafe number at +5 since he should start going back up in an hour or so.

meant to say have you tried tuna? Sometimes the tuna water will entice them and they eat some and it’s food to get more liquids in him after vomiting

 

Basically getting him to eat a bit every hour slows down the drop

 

More important than the total drop is the hourly drop and he went from 191 to 147 so that’s not very sharp. If he drops another 50 he’s still at about 90-100.

 

If you’re super worried, maybe set your alarm to check him in 2 hours...?

 

He just had some more bites of the baby food.

Unfortunately I do not have plain tuna. I have a medium carb Wellness Signature select wet food that has tuna in it that he used to like in pre-diabetes days. But I shouldn't try that yet/now, right?

 

Who can sleep?

So start panicking then, not now?

 

123 +6. So slowing down, maybe. Trying to stay up for +7.

 

111 +7. Wishing that he had made the turn and gone up a little by now. I am really tired (2:30 a.m. here) but don't feel solid about going to bed yet.

 

108 +7.5.

 

123 +8.5.

 

Jenny your dedication is amazing! Youre doing GREAT!

 

What Jeanne said.

(((Jenny)))


Mogs
.

 

Jeanne, thanks for your encouragement. Many people to thank who helped me get get here, especially Ale. I am so grateful.

I finally felt like it was safe for me to try to sleep a little. Woke up at +10.5: 144. Just woke up again, time for the AMPS: 167.

I am absolutely bewildered by what happened last night and where we are now. He's never had this low a PS. The Lantus (1/4 unit) has never taken that long to reach a nadir, and then been so slow to come up again. I don't understand it at all. Was it just the vomiting that made everything go haywire? Is something wrong/different with the insulin (same bottle as early September; vet said it would be fine to use as it's been in the fridge since then)? Did I get the dose wrong?
167 is too low for me to shoot according to the vet. I am afraid it would hurt him if I tried to do less going by the SLGS method, which I would *NOT* do on my own due to the 167 -- I would wait for guidance, but I am kind of too petrified after last night to try.

 

Thank you, Mogs. I am so tired and crying a little as I type this. No idea what to do now, but I am afraid that anything would be too much because I don't know enough and I don't understand what happened at all.

 

Hi @Jenny Ellen I was over here writing about the auto-feeder when I saw your post - @Critter Mom may be able to advise but generally with a lower pre-shot number (i.e. one that's safe to shoot but you may not be comfortable shooting), the advice is to NOT FEED and test again in 20 minutes. This way you can see if Comet is on the rise (i.e. last dose of insulin wearing off). Without input from someone with more experience than me, you also skip (or decide in 20 minutes).

I'll post about the auto-feeder too

 

Thanks, Jax. I just scanned again -- half an hour later, only up from 167 to 170. It makes no sense to me.

 

What I only have as a note in the spreadsheet is that he did not get any insulin between 9/26 PM to 10/17 PM because he was always what his vet said was too low to shoot. He was going up and down on his own, she liked what she was seeing -- he did not get into the 50-99 range on his own, but she thought he might get there.

Editing to clarify that last sentence. Her goal for him wasn't to get him as low as 50, she wants him no lower than 70 and said it was hard to get that safely with cats on insulin. She was pleased because he was getting to 125 or 150 under his own steam and only getting up to 250 or so. She and another vet at the practice thought he was beginning to regulate.

 

Hi Jenny,

Just going to look at Comet's spreadsheet for a minute. In the meantime, have one of these: --->

BRB...


Mogs
.

 

Hi Jenny,

Some questions:

1. Is Comet eating properly now?

2. Does Comet have any history of producing ketones or diabetic ketoacidosis?

3. Is Comet underweight?


Mogs
.

 

1. Mostly? He hasn't had anything for a few hours. I fed him some FF at around 3:00, nothing since then.
2. No. He has always tested negative for ketones when I test his pee.
3. Yes. The vet didn't seem that worried about it and said some of it could just be age-related (he is sixteen). He is 9.4 now. He was 10.8 before diagnosis, but was last weighed a few years prior to that.So maybe age? But one of the reasons I brought him in to get checked out was in addition to the drinking/peeing, he felt lighter to me.

 

Further additions to the above:
1. I should note that I didn't give him very much as I did not want it to come up. I just wanted to make sure he had something before I tried sleeping.

3. I don't know if this helps, but his brother, who does not have diabetes, also weighed less than he had a few years ago. So maybe age-related? But the diabetes diagnosis did not not make think that was the only reason.

 

Just checked at close to an hour after AMPS: 168.

So AMPS: 162
stall 1/2 hour: 170
stall another half hour: 168

Truly do not get it.

 

Thanks for the info, Jenny.

Considerations:

1. Appetite uncertain.
2. Not much recent BG data.
3. AMPS - first test under 200, also second test after stalling 30 minutes didn't show any rise.
4. No history of throwing ketones.
5. Previous strong response to 1/4 unit with depot only partly full (3rd dose at 1/4 unit), and today's PS BG level is lower than on that occasion.

Based on the above considerations, my suggestion would be to skip the dose this morning. I'd also suggest seeing whether Comet can eat properly and giving your vet a ring for advice/treatment.

What do you think, Jenny?


Mogs
.

 

PS:

I asked about Comet's weight because sometimes underweight kitties can have quite a strong response to even very small doses of insulin.


Mogs
.

 

You may be seeing the carryover from last night's dose.


Mogs
.

 

I am very willing to take this advice! Thank you so much, Mogs. I am really scared of shooting now. I will offer some food and see where we go, then contact the vet.

 

I can understand your worry completely. By way of a little reassurance, last night Comet was in really, really safe numbers and you did a sterling job of watching over him last night.

By way of general information, it can be completely safe to give Lantus insulin to a kitty when the preshot is lower than 200 BUT first you need to gather enough data to determine how the individual kitty responds. You're only at the data gathering stage at the moment, Jenny, but as you record more and more readings for Comet and build up the picture, you'll start to feel much more reassured of his safety on a given dose and gradually move him into a better BG range. All is good.

Be sure to let us know how you get on with the vet, and post for any help you need.

Treat yourself to something nice today after all your good work last night. And have another one of these: --->


Mogs
.

 

Thanks, Mogs

@Jenny Ellen - there is so much to learn but you may be interested in reading about some basics of lantus - check out this sticky - it has some info on the terms of Carryover/Overlap/Depot/Bounce that you may find helpful.

Below is info on my auto-feeder - I agree with Elise that you'd probably want one for each cat or separate them at night. I have two cats and we keep them separate at night; I also transitioned my non-diabetic to the same food as Jax so that if Jax happened to get in his food, it wouldn't be a big deal.

I got the Cate Mate C500 - It has 5 compartments (1 open and 4 hidden) and ice packs. I ordered right from the manufacturer (link here) - I also ordered 2 extra ice packs in case I wanted to use it for AM and PM (so I'd just have to wash it out, reset the times, and put in new ice packs). I also have mine rotate to an empty spot 2 hours before shot time (though I'm sure Jax would not let any food go uneaten ). It's definitely an investment but I personally have felt it's worth it.

Hope that helps and hope you can get some rest today

 

Thank you, Mogs. Trying to feel reassured! I think previous scares make me see rapidly dropping (to me) numbers feel dangerous and when they don't seem like they're stopping... ugh. Especially at night.

 

Thanks, Susanne. I will check out those stickies. I am so thankful for them; I feel like my brain has become a lot less sticky since this started and I have a harder time retaining/remembering stuff. Will also look at the CateMate.

Unfortunately, I can't really separate them -- I live in a studio apartment. Even if I had another room, they would probably cry all night about not being able to get to each other. They are both on the same diet as it would be hard to manage different ones for both.

 

Oh it's overwhelming! Hang in there! Keep asking questions and read stickies as you have the time

And gotcha on your kitties & your studio - that's sweet they love each other! Mine are brothers but have always just tolerated one another...we have always said each would have been happier as a "single" cat lol.

 

Hey Jenny!
Aint Mogs amazing?
You have earned yourself a nap!